Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

BACKGROUND

The effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.

AIM

To analyze whether CKD had specific effect on the outcomes after CRC surgery.

METHODS

We searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.

RESULTS

A total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, < 0.01) than the non-dialysis group.

CONCLUSION

Preexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.