Sando Masanori, Uehara Kay, Li Yuanying, Ogura Atsushi, Murata Yuki, Mizuno Takashi, Yatsuya Hiroshi, Ebata Tomoki
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan.
J Anus Rectum Colon. 2023 Jul 25;7(3):176-185. doi: 10.23922/jarc.2022-059. eCollection 2023.
Despite the high incidence of urinary dysfunction (UD) after rectal surgery, it remains questionable whether UD causes future chronic kidney disease (CKD). This study aimed to clarify the long-term trends in renal function and risk factors for future CKD after rectal resection.
For comparison, patients who underwent rectal resection (n = 129) and colectomy (n = 127) between 2006 and 2017 were identified. The estimated glomerular filtration rate (eGFR) ratio was calculated as the ratio to the baseline. "eGFR ratio < 0.75 at 3-year" was adopted as a surrogate indicator of future CKD.
eGFR ratio significantly decreased in the rectal cohort compared with the colon cohort at 1.5 years (0.9 vs. 0.95, = 0.008) and at 3 years (0.85 vs. 0.94, < 0.001). Although the preoperative prevalence of CKD was lower in the rectal than the colon cohort (13.9% vs. 23.6%, = 0.055), it was similar at 3 years (29.5% vs. 30.7%). In multivariate analysis, females, and cT4 were independent risk factors for future CKD, but UD itself was not.
Postoperative eGFR significantly decreased after rectal cancer surgery compared to colectomy. The prevalence of CKD more than doubled at 3 years after rectal resection. The female sex and cT4 tumor, instead of the UD, were independent risk factors for future CKD.
尽管直肠手术后排尿功能障碍（UD）的发生率很高，但UD是否会导致未来的慢性肾脏病（CKD）仍存在疑问。本研究旨在阐明直肠切除术后肾功能的长期变化趋势以及未来发生CKD的危险因素。
为作比较，确定了2006年至2017年间接受直肠切除术的患者（n = 129）和结肠切除术的患者（n = 127）。计算估计肾小球滤过率（eGFR）比值作为与基线的比值。采用“3年时eGFR比值<0.75”作为未来CKD的替代指标。
与结肠队列相比，直肠队列在1.5年时（0.9对0.95，P = 0.008）和3年时（0.85对0.94，P<0.001）eGFR比值显著下降。尽管直肠队列中CKD的术前患病率低于结肠队列（13.9%对23.6%，P = 0.055），但在3年时相似（29.5%对30.7%）。多因素分析显示，女性和cT4是未来发生CKD的独立危险因素，但UD本身不是。
与结肠切除术相比，直肠癌手术后术后eGFR显著下降。直肠切除术后3年时CKD的患病率增加了一倍多。女性和cT4肿瘤而非UD是未来发生CKD的独立危险因素。
