Ureteral decompression in advanced nonurologic malignancies

Background: The purpose of this study was to assess the morbidity and determine survival after ureteral decompression in patients with advanced nonurologic malignancies. Methods: Between June 1988 and June 1993 78 patients were referred to a single surgeon for ureteral decompression. Records were analyzed in relation to primary diagnosis, early and late complications, number of hospitalizations, and survival after decompression. Results: Seventy-two percent of patients initially underwent decompression endoscopically, and 28% required percutaneous nephrostomy placement at initial decompression. Complications occurred in 50% of patients and most commonly included infection (29%), stent obstruction and encrustation (28%), and gross hematuria (9%). The median survival for all patients after the first decompression procedure was 6.8 months (range 0.5-46.1), with an actuarial survival rate at 1 year of 55% and at 3 years of 30%. The eight patients with gastric/pancreatic cancer survived a median of just 1.4 months after decompression (range 0.77-11.8), with a 1-year actuarial survival rate of 12.5% and 3-year actuarial survival of 0%, which was significantly worse when compared with all other groups taken together or individually (p < 0.03). Conclusions: Ureteral decompression procedures in patients with advanced cancer can be an important component of palliative care but are associated with significant morbidity (50%) in patients whose median survival is <7 months. The role of ureteral decompression in patients with advanced gastric and pancreatic cancer is limited.