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. 2023 Nov;25(11):2225-2232.
doi: 10.1111/codi.16768. Epub 2023 Oct 6.

Postoperative decline in renal function after rectal resection and all-cause mortality: a retrospective cohort study

Joseph P Borucki  1   2   3   4 , Rebecca Woods  2   4 , Alexandra Fielding  2   4 , Lucy-Ann Webb  2   4 , James M Hernon  2   3   4 , Simon W Lines  5 , Adam T Stearns  2   3   4
Affiliations

Postoperative decline in renal function after rectal resection and all-cause mortality: a retrospective cohort study

Joseph P Borucki et al. Colorectal Dis. 2023 Nov.

Abstract

Aim: Fluid loss, dehydration and resultant kidney injury are common when a diverting ileostomy is formed during rectal cancer surgery, the consequences of which are unknown. The aim of this retrospective single-site cohort study is to evaluate the impact of sustained postoperative renal dysfunction after rectal resection on long-term renal impairment and survival.

Method: All patients with rectal adenocarcinoma undergoing resection between January 2003 and March 2017 were included, with follow-up to June 2020. The primary outcome was impact on long-term mortality attributed to a 25% or greater drop in estimated glomerular filtration rate (eGFR) following rectal resection. Secondary outcomes were the long-term effect on renal function resulting from the same drop in eGFR and the effect on long-term mortality and renal function of a 50% drop in eGFR. We also calculated the effect on mortality of a 1% drop in eGFR.

Results: A total of 1159 patients were identified. Postoperative reductions in eGFR of 25% and 50% were associated with long-term overall mortality with adjusted hazard ratios of 1.84 (1.22-2.77) (p = 0.004) and 2.88 (1.45-5.71) (p = 0.002). The median survival of these groups was 86.0 (64.0-108.0) months and 53.3 (7.8-98.8) months compared with 144.5 (128.1-160.9) months for controls. Long-term effects on renal function were demonstrated, with those who sustained a >25% drop in renal function having a 38.8% mean decline in eGFR at 10 years compared with 10.2% in controls.

Conclusion: Persistent postoperative declines in renal function may be linked to long-term mortality. Further research is needed to assess causal relationships and prevention.

Keywords: rectal cancer; renal function.

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References

REFERENCES

    1. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164.
    1. Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M. Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg. 2007;246(2):215-221.
    1. Memon MA, Yunus RM, Memon B, Awaiz A, Khan S. A meta-analysis and systematic review of perioperative outcomes of laparoscopic-assisted rectal resection (LARR) versus open rectal resection (ORR) for carcinoma. Surg Laparosc Endosc Percutan Tech. 2018;28(6):337-348.
    1. Martínez-Pérez A, Carra MC, Brunetti F, de'Angelis N. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: a systematic review and meta-analysis. World J Gastroenterol. 2017;23(44):7906-7916.
    1. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;16(2):CD007635.

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