Role of percutaneous nephrostomy in cancer patients

Abstract

Ureteric obstruction is common in cancer patients, representing an unfavorable prognostic factor in this population. Percutaneous nephrostomy (PCN) is often performed in these patients to prevent renal dysfunction and potentially increase survival. However, this procedure may negatively affect patients’ quality of life, and its survival benefit is not established. The objective is to characterize the population of cancer patients undergoing PCN, assess complications related to PCN, and identify potential prognostic factors in this population. Ninety-two patients were included; the median age was 70 years (range: 26–85), and 55 (60%) were males. Most patients had metastatic disease (n = 51; 55%). Bladder (n = 24; 26%), prostate (n = 15; 16%), and rectum (n = 10; 11%) were the most frequent primary tumor topographies. Twenty-seven patients (29%) had NPC-related complications, 16 (17%) had more than one complication, and 20 (22%) required hospitalization. The most frequent complications were infection (n = 23; 25%) and obstruction (n = 14; 15%). In the multivariate analysis, malignant obstructive uropathy was the only independent prognostic factor post-PCN. After three years of follow-up, 70 patients (76%) had died, mainly from cancer progression, and 2 (2%) due to PCN-related complications. Given the potential benefits and burdens, patients and, in some cases, family members should be involved in the decision. The problem is not the efficacy of PCN but the adequacy of the decision in the face of a limited life expectancy.