Effects of Chronic Kidney Disease on Outcomes of Hepatic Resection
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RESEARCH COMMUNICATION
Effects of Chronic Kidney Disease on Outcomes of Hepatic Resection Yoshihiro Inoue 1,2 & Yusuke Tsuchimoto 3 & Akira Asai 3 & Shinya Fukunishi 3 & Fumiharu Kimura 4 & Kazuhide Higuchi 3 & Kazuhisa Uchiyama 2 Received: 12 April 2020 / Accepted: 17 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Chronic kidney disease . Hepatocellular carcinoma . Hepatic resection
Introduction Recently, chronic kidney disease (CKD) has become a widely accepted classification1, 2 and attracted attention as a risk factor for perioperative complications. Patients with CKD are increasingly undergoing surgical treatment owing to the rising incidence of complications, including hepatocellular cancer (HCC). We aimed to investigate the effects of CKD on perioperative hepatectomy outcomes.
Methods This retrospective study reviewed the surgical outcomes of 369 patients who underwent hepatic resection for HCC. CKD status was determined by the estimated glomerular filtration rate,3 and the outcomes of patients with and without CKD were compared after propensity score matching (PSM).
* Yoshihiro Inoue [email protected] 1
Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, 8-1 Tamagawa-shinmachi, Takatsuki City, Osaka 569-0856, Japan
2
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
3
Second Department of Internal Medicine, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
4
Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, 8-1 Tamagawa-shinmachi, Takatsuki City, Osaka 569-0856, Japan
Associations of CKD with surgical outcomes and remnant liver regeneration were analyzed.
Results Overall, 145 (39.3%) and 224 (60.7%) patients did and did not have CKD, respectively. In two (0.5%) patients, surgery was delayed for 1 month because of CKD severity and was performed once the renal function had improved by adjusting medications. After PSM, surgical duration, blood loss volume, postoperative complications (Clavien–Dindo grade > IIIA), and incidence rates of infectious complications and post-hepatectomy liver failure did not significantly differ between the groups (P = 0.685, 0.198, 0.726, 0.313, and 0.307, respectively, Table 1). No serious acute renal failure cases and cardiovascular complications were noted. The CKD group had significantly worse serum creatinine (Cr) concentrations immediately postoperatively and on postoperative days 1, 2, 4, 7, and 14 (P < 0.001, < 0.001, < 0.001, < 0.001, and = 0.018, respectively, Table 2). However, other postoperative laboratory data did not significantly differ. No differences in remnant liver regeneration at 7 days and 1, 2, 5, and 12 months postoperatively (P = 0.055, 0.802, 0.431, 0.625, and 0.708, respectively, Table 3) were also observed. Overall or recurrence-free survival rates were not significantly different (P = 0.243 and 0
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