Department of General, Visceral and Transplantation Surgery, Frankfurt University Hospital and Clinics, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
Department of Nephrology, Frankfurt University Hospital and Clinics, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
BMC Geriatr. 2021 Jan 19;21(1):65. doi: 10.1186/s12877-020-02001-z.
Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients.
A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis.
SCr before LAR(T) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at Twere able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68).
DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.
低位前切除术（LAR）常联合预防性回肠造口术（DLI）用于保护直肠癌患者的吻合口。本研究旨在分析对于接受 LAR 治疗的直肠癌患者，与年轻患者相比，老年患者在 LAR 后行 DLI 造口和关闭后肾功能下降的风险是否更高。
本研究使用数据库中的回顾性队列研究，纳入了 151 例行 LAR 治疗合并 DLI 的直肠癌患者。患者被分为两个年龄组（A 组：<65 岁，n=79；B 组：≥65 岁，n=72）。对 123 例行 DLI 反转的患者进行分析，使用多元线性回归分析 DLI 反转后 3 个月血清肌酐（SCr）和估算肾小球滤过率（eGFR）受损的预后因素。
LAR 前的 SCr 在 B 组显著升高（P=0.04）。相应地，B 组的 eGFR 在 T 时显著降低（P<0.001）。无患者在 LAR 或 DLI 反转后需要进行血液透析。年龄和 T 时的 SCr 能够显著预测 DLI 反转后 3 个月 SCr（P<0.001）和 eGFR（P=0.001）的增加（整体模型的 R²为.82（调整 R²=.68））。
DLI 的建立可能导致 DLI 关闭后 3 个月老年患者的 eGFR 降低。除此之外，无论年龄大小，LAR 后行 DLI 造口和关闭不会导致更高的发病率。
