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- Title
Impact of chronic kidney disease on postoperative outcome following colorectal cancer surgery.
- Authors
Currie, A.; Malietzis, G.; Askari, A.; Nachiappan, S.; Swift, P.; Jenkins, J. T.; Faiz, O. D.; Kennedy, R. H.
- Abstract
Aim Chronic kidney disease ( CKD) is increasing in prevalence and is associated with cardiovascular events and mortality in asymptomatic and vascular surgery populations. This study aimed to determine the role of CKD in stratifying peri- and postoperative risk for colorectal cancer ( CRC) patients with nonmetastatic disease undergoing elective curative resection. Method Patients diagnosed with nonmetastatic colorectal adenocarcinoma and undergoing surgical resection between 2006 and 2011 were identified from a prospectively collated database. Further information on survival and cause of death was gathered from a regional cancer registry. Estimated glomerular filtration rates were calculated using the Modification of Diet in Renal Disease ( MDRD) equation. Kaplan-Meier survival curves were constructed for disease-free and overall survival. Multivariate Cox regression models were used to determine the role of CKD after stratification by several clinicopathological factors. Results Seven-hundred and eight colorectal resections were studied [median follow up: 45 (interquartile range, 21-65) months). Overall postoperative complications were similar, but patients with CKD were more likely to develop cardiovascular morbidity ( P < 0.001) and 30-day mortality [4.8% (six of 124) in the CKD group vs 2.1% (12/580) in the non- CKD group]. Kaplan-Meier analysis revealed poorer overall survival for localized (Stage I- II; P = 0.019) and Stage III ( P = 0.001) CRC in the CKD population. Multivariate Cox regression analysis identified CKD as an independent prognostic factor for noncancer death [hazard ratio ( HR) = 1.82 (95% CI: 1.07-3.10); P = 0.027] but not for overall survival [ HR = 1.21 (95% CI: 0.90-1.47); P = 0.116]. Conclusion Patients with CKD may be more likely to develop cardiovascular complications following CRC resection and have an increased risk of a noncancer death. Future research should explore the interaction of CKD in competing mortality risks following CRC surgery.
- Subjects
CHRONIC kidney failure; COLON cancer; MORTALITY; PROCTOLOGY; MULTIVARIATE analysis; KIDNEY diseases
- Publication
Colorectal Disease, 2014, Vol 16, Issue 11, p879
- ISSN
1462-8910
- Publication type
Article
- DOI
10.1111/codi.12665