Hydronephrosis associated with colorectal carcinoma: treatment and outcome

Aim: Obstruction of the upper urinary tract, hydronephrosis, is not uncommo n in the context of primary or recurrent colorectal cancer (CRC). Its prese nce poses a therapeutic dilemma. This study focuses on the significance of hydronephrosis as a prognostic marker for CRC by analysing the resectabilit y and survival rates of patients affected, Patients and Methods: Retrospective data of 52 patients with hydronephrosis were analysed. Ten had primary CRC at different sites and 42 developed hyr onephrosis 1-84 months following resection of a primary CRC. Twenty eight h ad unilateral and 24 bilateral hydronephrosis. Results: In 10 patients with primary CRC and in 38 of those with a history of CRC, hydronephrosis was secondary to malignant obstruction. In four it w as related to iatrogenic injury to the urinary tract. Complete surgical res ection was possible in five patients (10%) with malignant obstruction. The remaining 90% underwent palliative or no surgical treatment due to diffuse metastasis or extensive local disease. No difference in survival was found between these two groups (6 vs 8 months) nor when comparing CEA levels, Duk e's staging, or unilateral vs bilateral hydronephrosis. Patients with benig n obstruction were treated by a ureteric stent, leading to resolution of hy dronephrosis. All four are alive. Conclusions: Malignant hydronephrosis, secondary to primary or recurrent CR C, represents local manifestation of a disseminated disease with almost no probability of long-term survival and cure. It would seem that patients wit h such disease do not benefit from aggressive operations. (C) 2001 Harcourt Publishers Ltd.