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Kidney Week

Abstract: FR-PO040

Renal Outcomes of Laparoscopic versus Open Surgery in Patients with Rectal Cancer: A Propensity Score Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Paek, Jin hyuk, Keimyung University School of Medicine, Daegu, Korea (the Republic of)
  • Ryu, Ji Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Son, Hyung Eun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

The laparoscopic approach in abdominal surgery is widely used and has many advantages over open surgery (OS). However, the renal outcomes of laparoscopic surgery (LS) are still not proven in rectal cancer. Thus, we compared the renal outcomes between LS and OS in patients with rectal cancer.

Methods

We conducted a retrospective cohort study of 1633 patients who underwent rectal cancer surgery between 2003 and 2017. Postoperative acute kidney injury (AKI) was determined according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification. AKI stage 2 or 3 were classified as severe AKI and AKI recovery was defined as return of serum creatinine to < 1.2 times the baseline level.

Results

Among 1633 patients, 1072 patients (65.6%) underwent LS. The incidence of postoperative AKI in LS was significantly lower than in OS (9.3 vs. 17.3%, p < 0.001, respectively). After matching propensity scores (1:1), 395 patients were included in each group. LS group still demonstrated a significantly lower incidence of postoperative AKI than OS group (9.9 vs. 15.9%, p = 0.011, respectively). The operation time (p < 0.001), estimated blood loss (p < 0.001), incidence of transfusion (p < 0.001) in LS group were significantly lower than in OS group. However, there were no differences in incidence of severe AKI (p = 1.000), AKI recovery (p = 0.962) and in-hospital mortality (p = 0.249) between two groups. Cox proportional hazard models revealed that LS group had lower incidence of postoperative AKI than OS group (HR, 0.599; 95% CI, 0.402-0.893; p = 0.012). In subgroup analysis, LS had much lower incidence of postoperative AKI than OS in patients with American Society of Anesthesiologists (ASA) score ≤ 2 (HR, 0.516; 95% CI, 0.314-0.850; p = 0.009) and in patients who did not receive neoadjuvant chemotherapy (HR, 0.519; 95% CI, 0.295-0.912; p = 0.023).

Conclusion

This study showed that LS may reduce postoperative AKI in patients with rectal cancer and that its beneficial effect may be associated with operation time or intraoperative bleeding events and be dominant in patients with low ASA score and no neoadjuvant chemotherapy.