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Impact of Chronic Kidney Disease on Outcomes of Surgical Resection for Primary Colorectal Cancer: A Retrospective Cohort Review

BACKGROUND: Chronic kidney disease, a disease entity increasing in number, may be an obstacle in various aspects of treatment for malignant neoplasm, such as perisurgical management and implementation of chemotherapy. OBJECTIVE: The aim of this study was to evaluate both short- and long-term outcomes of patients with colorectal cancer who have chronic kidney disease. DESIGN: This study is a retrospective cohort study of patients. SETTINGS: This study as conducted at an academic tertiary hospital in Japan. PATIENTS AND INTERVENTIONS: We investigated 1127 consecutive patients with stages 0 to III primary colorectal cancer who underwent curative resection in our department from January 2001 to December 2010. Based on estimated glomerular filtration rate, patients were classified into stages 0 to 2 (including normal renal function, 882 patients, 78.2%), stages 3 to 4 (226 patients, 20.1%), or stage 5 chronic kidney disease (19 patients, 1.7%). MAIN OUTCOME MEASURES: Clinicopathological data, perioperative course, frequencies of postoperative complications, adjuvant chemotherapy, and recurrence-free and overall survivals after surgery for colorectal cancer were compared among the 3 different chronic kidney disease stage groups. RESULTS: Patients with chronic kidney disease stage 5 frequently experienced diabetes mellitus and cardiovascular comorbidities. They were also hypoalbuminemic and anemic and more likely to receive blood transfusions, although estimated blood loss was smaller during surgery than in the other patients. Perioperative cardiovascular complications were more frequent in the chronic kidney disease stages 3 to 4 and 5 groups (5.3%) than those in the stages 0 to 2 group (0.8%, p < 0.0001). However, the frequencies of other complications were similar. There were no differences in the frequency of adjuvant chemotherapy and recurrence-free survival among different chronic kidney disease stages; in contrast, the chronic kidney disease stage 5 group showed a poorer overall survival. LIMITATIONS: The study is limited by its retrospective nature. CONCLUSIONS: From these data, we conclude that surgical resection for colorectal cancer in patients with chronic kidney disease can be performed with acceptable outcomes.