Kozlowski Leszek, Malyszko Jolanta
Department of Oncological Surgery, Bialystok Cancer Center, Poland.
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Poland.
Contemp Oncol (Pozn). 2022;26(3):187-190. doi: 10.5114/wo.2021.111057. Epub 2021 Nov 24.
Acute kidney injury (AKI) is a frequent postoperative complication. However, data on the incidence of AKI in patients with colorectal cancer (CRC) undergoing surgery with curative intent are still limited. We examined the relationship between postoperative AKI among CRC surgery patients and preoperative therapy or no prior therapy.
A total of 326 consecutive patients from the regional oncology center undergoing CRC surgery in the period January to December 2019 were included in the observational cohort study. We defined AKI as a 50% increase in plasma creatinine or initiation of renal replacement therapy within 7 days after surgery or an absolute increase in creatinine of 0.3 mg/dl within 48 hours.
Acute kidney injury occurred in 36 patients (11%), 27 of whom underwent rectum resection, and 9 underwent colon resection. The incidence of AKI was identical in both types of surgery. Among 54 patients undergoing neoadjuvant radiochemotherapy, 6 patients (11%) developed AKI, while there was no case of AKI in 31 patients with neoadjuvant radiotherapy. Among 36 patients with AKI, 33 had hypertension, 27 had diabetes and 18 had at least stage 3 of chronic kidney disease before the surgery.
Acute kidney injury after surgery for CRC is a relatively frequent postoperative complication, in particular, in patients with prior impairment in kidney function and comorbidities such as hypertension and diabetes. Appropriate preoperative therapy, including optimal hydration, withdrawal of potentially nephrotoxic drugs, etc., may reduce the incidence of AKI.
急性肾损伤（AKI）是常见的术后并发症。然而，关于接受根治性手术的结直肠癌（CRC）患者中AKI发生率的数据仍然有限。我们研究了CRC手术患者术后AKI与术前治疗或未接受过治疗之间的关系。
2019年1月至12月期间，来自地区肿瘤中心的326例连续接受CRC手术的患者纳入观察性队列研究。我们将AKI定义为术后7天内血浆肌酐增加50%或开始肾脏替代治疗，或48小时内肌酐绝对增加0.3mg/dl。
36例患者（11%）发生急性肾损伤，其中27例行直肠切除术，9例行结肠切除术。两种手术的AKI发生率相同。在54例接受新辅助放化疗的患者中，6例（11%）发生AKI，而31例接受新辅助放疗的患者中无AKI病例。在36例发生AKI的患者中，33例术前有高血压，27例有糖尿病，18例术前至少患有3期慢性肾病。
CRC手术后的急性肾损伤是一种相对常见的术后并发症，特别是在术前肾功能受损以及患有高血压和糖尿病等合并症的患者中。适当的术前治疗，包括优化补液、停用潜在肾毒性药物等，可能会降低AKI的发生率。
