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Kidney Week

Abstract: FR-PO085

Laparoscopic Gastrectomy Lowers Postoperative AKI in Stomach Cancer Patients: A Propensity Score Analysis

Session Information

  • AKI: Clinical Outcomes, Trials
    November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ryu, Ji Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Kim, Kipyo, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chae, Dong-Wan, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

Acute kidney injury (AKI) is a common and morbid complication in the surgical patient, but there are insufficient reports on AKI after abdominal surgery. Thus, we compared the renal outcomes, including AKI, of stomach cancer patients who underwent laparoscopic surgery (LS) and open surgery (OS).

Methods

We conducted a retrospective cohort study of 6603 patients who underwent stomach cancer surgery between 2003 and 2017. Postoperative AKI was determined according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification.

Results

Of the 6603 patients, 5190 patients (78.6%) underwent LS and 1413 patients (21.4%) underwent OS. The incidence of postoperative AKI in LS group was significantly lower than in OS group (2.9% vs. 7.8%, respectively, p < 0.001). After matching propensity scores (1:1), 714 patients were included in each group. Cox proportional hazard models adjusted for age, sex, smoking, BMI, American Society of Anesthesiologists (ASA) score, tumor size, preoperative hemoglobin (Hb), and cancer stage in entire cohort revealed that the LS group had lower incidence of postoperative AKI than the OS group (HR, 0.545; 95% CI, 0.400-0.742; p < 0.001, respectively). The effects were also consistent in matched cohort (HR, 0.527; 95% CI, 0.333-0.834; p=0.006). But, there was no significant difference in the risk of 1 year survival after surgery between groups in matched cohort (HR, 0.836; 95% CI, 0.413-1.697; p=0.618). Its reduction in risk for postoperative AKI in the LS group was also consistent with subgroup analysis including all groups of age, sex and BMI. And, the effect of reducing the incidence of postoperative AKI in the LS group was remarkable in the lower preoperative Hb, ASA score, and cancer stage.

Conclusion

Our findings suggest that postoperative AKI with stomach cancer after gastrectomy has been attenuated in the LS group, especially in the subgroup including low ASA score, low hemoglobin, small tumor size, low grade cancer stage and smoking.