Suzuki Satoshi, Kanaji Shingo, Urakawa Naoki, Takiguchi Gosuke, Hasegawa Hiroshi, Yamashita Kimihiro, Matsuda Takeru, Oshikiri Taro, Nakamura Tetsu, Kakeji Yoshihiro
Division of Gatrointestinal Surgery Department of Surgery Graduate School of medicine Kobe University Kobe Japan.
Ann Gastroenterol Surg. 2021 Feb 12;5(4):519-527. doi: 10.1002/ags3.12441. eCollection 2021 Jul.
The outcomes of gastrectomy for gastric cancer in patients at each severity of chronic kidney disease (CKD) remain unknown.
We retrospectively analyzed the outcomes of 560 patients who underwent distal or total gastrectomy for gastric cancer between 2009 and 2018. We classified the patients into four groups based on estimated glomerular filtration rate: stage 1/2 (normal to mild, n = 375), stage 3a (mild to moderate, n = 122), stage 3b (moderate to severe, n = 43), and stage 4/5 (severe to end-stage, n = 20) CKD. The relationship between CKD stage and the incidence of postoperative morbidity was analyzed.
CKD was a predictor of overall morbidity independent of age, gender, American Society of Anesthesiologists Performance Status, pulmonary comorbidity, extent of lymphadenectomy, and operation time in a multivariate analysis. The incidences of overall and severe morbidity were significantly increased with CKD progression (both .001). Compared to stage 1/2 CKD, the odds of overall morbidity were significantly elevated in stage 3a (odds ratio [OR] 1.87.007), stage 3b (OR 3.86.001), and stage 4/5 (OR 8.60.001). The risk of procedure-related morbidity was strikingly increased in stage 3b (OR 2.93.004). The risk of procedure-unrelated morbidity elevated markedly in stage 3a (OR 2.77.001). A significant graded association between CKD progression and overall morbidity was also revealed in elderly patients (.001).
The severity of CKD predicts the likelihood and type of morbidity after gastrectomy and can guide surgical decision-making for patients with gastric cancer.
慢性肾脏病（CKD）各严重程度患者胃癌胃切除术后的结局仍不明确。
我们回顾性分析了2009年至2018年间560例行远端或全胃切除术治疗胃癌的患者的结局。根据估计的肾小球滤过率将患者分为四组：1/2期（正常至轻度，n = 375）、3a期（轻度至中度，n = 122）、3b期（中度至重度，n = 43）和4/5期（重度至终末期，n = 20）CKD。分析了CKD分期与术后并发症发生率之间的关系。
在多因素分析中，CKD是总体并发症的预测因素，独立于年龄、性别、美国麻醉医师协会身体状况、肺部合并症、淋巴结清扫范围和手术时间。总体和严重并发症的发生率随CKD进展显著增加（均为P<0.001）。与1/2期CKD相比，3a期总体并发症的几率显著升高（优势比[OR]1.87，P = 0.007），3b期（OR 3.86，P<0.001）和4/5期（OR 8.60，P<0.001）。3b期与手术相关并发症的风险显著增加（OR 2.93，P = 0.004）。3a期与手术无关并发症的风险显著升高（OR 2.77，P<0.001）。老年患者中也显示出CKD进展与总体并发症之间存在显著的分级关联（P<0.001）。
CKD的严重程度可预测胃切除术后并发症的可能性和类型，并可指导胃癌患者的手术决策。
