Management of malignant ureteric obstruction in patients with gastric cancer: survival outcomes from a 10-year experience

Abstract

Objective: To compare survival outcomes between different treatment options of malignant ureteric obstruction secondary to gastric cancer. Patients and Methods: Cases of hydronephrosis secondary to gastric cancer from Jan 2006 to Dec 2016 in Queen Mary Hospital were retrospectively analysed. Drainage methods including ureteric stent, PCN, and conservative management were compared. Primary outcomes include disease‐specific and overall survival rates. Secondary outcomes include treatment failure rate and subsequent systemic therapy usage. Results: 52 cases in 32 patients were identified. The median survival after diagnosis of hydronephrosis was 4 months. Ureteric stent and PCN had no significant difference in disease‐specific (p = 0.143) and overall survival (p = 0.143). Ureteric stent had, however, significantly higher failure rate than PCN (44.4% vs 13.3%, p = 0.040). Ureteric stent and PCN had no difference in systemic therapy use (p = 0.890). Drainage of hydronephrosis had a higher trend of systemic therapy use than conservative treatment (45.2% vs 20.0%), but statistical significance could not be reached (p = 0.144). Drainage did not lead to better disease‐specific (p = 0.373) and overall survival (p = 0.822) when comparing with conservative treatment. Conclusion: There was no significant difference in survival outcomes between different treatment options. Decision for drainage should take into account patients’ symptoms and quality of life following the treatment options.