Renal Dysfunction after Rectal Cancer Surgery: A Long-term Observational Study

Masanori Sando; Kay Uehara; Yuanying Li; Atsushi Ogura; Yuki Murata; Takashi Mizuno; Hiroshi Yatsuya; Tomoki Ebata

doi:10.23922/jarc.2022-059

Renal Dysfunction after Rectal Cancer Surgery: A Long-term Observational Study

J Anus Rectum Colon. 2023 Jul 25;7(3):176-185. doi: 10.23922/jarc.2022-059. eCollection 2023.

Authors

Masanori Sando¹, Kay Uehara¹, Yuanying Li², Atsushi Ogura¹, Yuki Murata¹, Takashi Mizuno¹, Hiroshi Yatsuya³, Tomoki Ebata¹

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan.
³ Department of Public Health, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Abstract

Objectives: 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.

Methods: 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.

Results: eGFR ratio significantly decreased in the rectal cohort compared with the colon cohort at 1.5 years (0.9 vs. 0.95, p = 0.008) and at 3 years (0.85 vs. 0.94, p < 0.001). Although the preoperative prevalence of CKD was lower in the rectal than the colon cohort (13.9% vs. 23.6%, p = 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.

Conclusions: 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.

Keywords: chronic kidney disease; postoperative complication; rectal cancer; renal dysfunction; urinary dysfunction.