Ureteral injuries during colorectal surgery

This study analyzed the incidence and risk of ureteral injuries following colorectal surgery.

Colorectal surgery is often required to treat cancer of the colon or the rectum. Although all surgeries carry an inherent risk, the ureters (thin tubes connecting the kidneys and the bladder) are especially vulnerable to injury during colorectal surgery. However, no studies to date have analyzed the incidence and possible risk factors leading to ureteral injury during colorectal surgery.

The outcomes of colorectal surgeries in the United States over the past 10-years were analyzed in this study. Approximately 2,165,848 surgeries were preformed. Overall, 6027 ureteral injuries were reported; resulting in an incidence of 0.28%. Both colon and rectal cancer were found to significantly increase the risk of ureteral injuries during surgery, compared to colorectal surgery due to other causes. Previous abdominal surgery and metastatic (wide spread) cancer were also associated with an increased risk of ureteral damage.

Surgery performed at a teaching hospital was associated with a 5% increased risk for ureteral injury. Surgery performed by laparoscopy, a minimally invasive surgical method, was associated with a 9% decrease in the risk of ureteral damage during surgery.

Advanced cancer was associated with a greater incidence of ureteral injuries compared to early stage tumors. Among all ureteral injuries occurring during colorectal surgery, 30.40% occurred in advanced cancer patients and 15.72% occurred in patients with cancer confined to the rectum or colon. Rectal cancer patients experienced the highest rate of ureteral injuries, occurring in 0.71% of surgeries, compared an incidence of 0.21% among colon cancer patients.

Colorectal surgery due to cancer significantly increases the risk of ureteral injury. Several factors were found to reduce the risk of ureteral injury, including laparoscopic surgery.