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. 2022 Jun 15;14(6):1199-1209.
doi: 10.4251/wjgo.v14.i6.1199.

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

Xiao-Yu Liu  1 , Bin Zhang  1 , Yu-Xi Cheng  1 , Wei Tao  1 , Chao Yuan  1 , Zheng-Qiang Wei  1 , Dong Peng  2
Affiliations

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

Xiao-Yu Liu et al. World J Gastrointest Oncol. .

Abstract

Background: The effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.

Aim: To analyze whether CKD had specific effect on the outcomes after CRC surgery.

Methods: We searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.

Results: A total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.

Conclusion: Preexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.

Keywords: Chronic kidney disease; Colorectal cancer; Meta-analysis; Outcome; Prognosis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Complications. A: Overall complications between the chronic kidney disease (CKD) group and the non-CKD group; B: Subgroup analysis of the non-dialysis groups; C: Subgroup analysis of the dialysis groups.
Figure 3
Figure 3
Overall survival. A: Overall survival between the chronic kidney disease (CKD) group and the non-CKD group; B: Subgroup analysis of the non-dialysis groups; C: Subgroup analysis of the dialysis groups.
Figure 4
Figure 4
Disease-free survival. A: Disease-free survival between the chronic kidney disease (CKD) group and the non-CKD group; B: Subgroup analysis of the non-dialysis groups; C: Subgroup analysis of the dialysis groups.
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