Impact of pretreatment asymptomatic renal dysfunction on clinical course after esophagectomy
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ORIGINAL ARTICLE
Impact of pretreatment asymptomatic renal dysfunction on clinical course after esophagectomy Yuki Kirihataya1 · Kohei Wakatsuki1 · Sohei Matsumoto1 · Hiroshi Nakade1 · Tomohiro Kunishige1 · Shintaro Miyao1 · Masayuki Sho1 Received: 3 March 2020 / Accepted: 28 June 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Recent large-scale clinical studies have shown that preoperative renal insufficiency is associated with an increased risk of postoperative complications after esophagectomy; however, it remains unclear whether asymptomatic renal dysfunction affects the postoperative course after esophagectomy. Methods The subjects of this retrospective study were 177 patients who underwent esophagectomy between May, 2009 and December, 2018. Renal function was evaluated based on the pretreatment estimated glomerular filtration rate (eGFR). Patients were divided into two groups according to the eGFR cut-off value of 55 ml/min per 1.73 m2. Results There were 17 patients in the low eGFR group and 160 patients in the normal group eGFR group. The rate of severe complications was significantly higher in the low eGFR than in the normal eGFR group. A low eGFR was the only significant complication risk factor identified; however, there were no marked differences in mortality or survival between the low and normal eGFR groups. Conclusion Our findings demonstrate that pretreatment asymptomatic renal dysfunction may be a significant risk factor for severe morbidity after esophagectomy. Keywords Esophagectomy · Renal dysfunction · Postoperative complication · Surgery
Introduction Esophagectomy for esophageal cancer is associated with higher morbidity and mortality rates (2.7–11.4%) than other gastrointestinal surgeries, although advances in surgical techniques and perioperative management have made it safer [1, 2]. Preoperative comorbidities are reportedly associated with postoperative complications in patients with esophageal cancer [3, 4]. Advanced age, poor performance status, corticosteroid use, squamous cell cancer, chronic lung disease, and malnutrition are known predictors of complications after standard esophagectomy [5–7]. Postoperative sepsis reflects severe impairment of the immune response, which is potentially associated with cancer recurrence and mortality [8]. Knowledge about the risks of postoperative complications is * Masayuki Sho m‑sho@naramed‑u.ac.jp 1
Department of Surgery, Nara Medical University School of Medicine, 840 Shijo‑cho, Kashihara, Nara 634‑8522, Japan
important for proper perioperative management and obtaining informed consent from patients. Renal dysfunction is a major risk factor related not only to the metabolic and coagulopathic disorders secondary to uremia and anuria, but also to other co-morbidities [9, 10]. Preoperative renal insufficiency is a well-known risk factor for postoperative complications after cardiac and vascular surgery [11, 12]. Preoperative renal failure and complications after cancer surgery have been reported, even in the subpopulation
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