Is Early Stenting Beneficial in Advanced Cervical Cancer : Prospective Study to Determine the Factors Predicting Successful DJ Stent Insertion in Malignant Ureteric Obstruction Secondary to Cervical Cancer

Abstract AIM To study the clinical, biochemical and radiological factors predicting successful DJ stent insertion in cases of advanced carcinoma cervix with obstructive uropathy in order to proactively stent patients with advanced cervical cancer at an earlier stage METHODS Prospective study where 109 patients of advanced Carcinoma cervix with obstructive uropathy were included. DJ stent insertion was considered successful if atleast one ureter was intubated. Clinical, laboratory and imaging parameters analysed with the primary outcome of successful DJS insertion using ROC curves. Sensitivity, specificity and accuracy calculated. FIsher's test and Chi square test used to calculate the value of significance. P < 0.05 considered significant. RESULTS 11%, 31%, 35%, and 22% of subjects had grade1, grade2, grade 3, grade 4 HUN respectively. DJS was successful in 66 patients. The likelihood of DJS declined with increase in tumor's size (chi sq 17.3, p = 0.0051) and HUN grade (chi sq 13.68, p = 0.003). Plotting ROC curves showed that serum albumin < 2.9 mg/dl (sn − 44% and sp − 83.3%), serum creatinine of > 4.4 mg/dl (sn -75%, sp − 80.95%), and serum urea level of more than 47 mg/dl (sn − 62%, sp = 88%) and eGFR < 11.2ml/min/1.73m² reduced the success of DJ stent. CONCLUSION Probability of successful DJ stent depends on grade of HUN, size of the tumour, eGFR ,serum albumin, presence of bladder infiltration and history of radiotherapy. Efficacy of diversion by DJS and PCN insertion with respect to return of renal function were not significantly different.