Perioperative Management and Surgical Outcomes of Colorectal Cancer Patients Undergoing Peritoneal Dialysis for End-Stage Kidney Disease

Abstract

Introduction: Despite the fact that the number of peritoneal dialysis (PD) patients is increasing, there is little evidence on the surgical outcomes of PD patients who have colorectal cancer surgery, and there is no consensus on the safety and practicality of continuing PD.

Methods: We retrospectively evaluated the short- and long-term results, as well as the feasibility of continuing PD, in eight patients with PD who had colorectal cancer surgery at our institution between January 2010 and January 2021.

Results: The scheduled open-fashioned resection was performed in one patient, whereas the other seven surgeries were all conducted laparoscopically, with no intraoperative conversion to laparotomy necessary. Except for one patient with a history of recurring PD-related peritonitis, the PD catheter was kept in seven of the eight cases. Five of the seven patients continuing PD underwent temporary postoperative hemodialysis. At a median of 24.5 months of postoperative monitoring, no infectious complications were observed, six cases continued PD, and no recurrence of colorectal cancer was observed in all cases.

Conclusions: Routine curative-intent colorectal cancer surgery with the preservation of the PD catheter is possible and safe in individuals receiving PD. This patient population's short- and long-term oncological results are comparable to general surgical outcomes of those without chronic kidney disease. PD can be maintained for a long period of time following major colorectal cancer surgery.

Keywords: colorectal cancer surgery; end-stage kidney disease; end-stage renal disease; perioperative management; peritoneal dialysis; surgical outcome.

Figure 1. Intraoperative findings from performing a laparoscopic left hemicolectomy of the colon (case 6).

Surgical procedures were done without much difficulty. (A) Preparing for medial dissection of sigmoid colon and rectum. (B) Status after medial dissection and lymph node dissection. (C) Dissecting mesorectum. (D) Relocating the PD catheter after putting an intraoperative drain in the pelvic cavity. Arrows indicate the PD catheter, and the arrowhead indicates an intraoperative drain.

Figure 2. X-ray and CT images of subcutaneous edema after postoperative peritoneal dialysis resumption (case 3).

(A) An abdominal X-ray shows the obviously low radiolucency area on the left abdomen (arrows). (B) The CT image shows subcutaneous edema spreading widely on the left lateral abdomen.