Comparison of Postoperative Acute Kidney Injury Between Laparoscopic and Laparotomy Procedures in Elderly Patients Undergoing Colorectal Surgery

Abstract

Objectives: Postoperative acute kidney injury (AKI) has an unfavorable impact on both short-term and long-term outcomes. The aim of this retrospective study was to compare the incidence of postoperative AKI between laparoscopic and laparotomy procedures in elderly patients undergoing colorectal surgery.Methods: Medical records of elderly (65 y and older) patients who underwent colorectal cancer surgery between May 2016 and July 2018 at our tertiary hospital were reviewed. Patients with Union Internationale Contre le Cancer (UICC) stage II and III colorectal cancer, without neoadjuvant treatment, were divided into laparoscopic procedure group and laparotomy group. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups, before and after propensity matching. Multivariable analysis was made to identify independent risk factors of AKI.Results: In all, 285 patients met the study inclusion criteria. Postoperative AKI occurred only in 16 patients from the laparotomy group (n = 212). The incidence of AKI was significantly lower in the laparoscopic procedure group (n = 73) compared with the laparotomy group (0% vs. 7.5%; P = 0.015). Seventy-three patients who underwent laparoscopic surgery were matched with 73 of 212 patients who underwent open surgery, by using propensity score analysis, and the incidence of AKI in the 2 groups was similar (0% vs. 8.3%; P = 0.028). Multivariable analysis showed that intraoperative metaraminol dose > 1 mg (odds ratio = 2.742, P = 0.042) is an independent risk factor for postoperative AKI. Conclusion:In elderly patients, the incidence of AKI after colorectal cancer surgery is lower in the laparoscopic procedure group, maybe related to hemodynamic stability and less vasoconstriction.

Acute kidney injury prevalence in patients with colorectal cancer undergoing surgery with curative intent

“…They also found that the in-hospital mortality of patients with AKI was 18.2%, whereas patients without AKI had an in-hospital mortality of 0.7%. In contrast to the study of Huang et al [20], we did not find a difference in the rate of AKI between laparotomy and laparoscopic procedure groups. They studied 285 patients and postoperative AKI occurred only in 16 patients (7.5%) from the laparotomy group (n = 212).…”

“…256 patients underwent rectum resection, and 70 underwent colon resection. The main methods of colon or rectal surgery performed in the department of surgery were: right hemicolectomy (58), left hemicolectomy (12), low anterior resection (185), high anterior resection (51), abdomino-perineal resection (20). Adenocarcinoma was diagnosed in all treated patients by endoscopy before qualifying for surgery.…”

Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management—a pilot randomized controlled trial

“…Here, we provide physiological clues to support the potential hazards of laparoscopic surgery, showing a rapid and substantial decrease in PuO 2 during laparoscopic procedures. However, some studies also reported lower acute kidney injury incidence in laparoscopic patients than in open surgery [34][35][36]. As we showed, open surgery is not free from renal medullary stress: although the fall appeared less sharp in open surgery, the PuO 2 still consistently decreased over time.…”

Management of acute kidney injury in gastrointestinal tumor: An overview

“…Widely recognized risk factors for AKI in cancer patients include the use of nephrotoxic drugs, angiotensin-converting enzyme inhibitors (ACEIs), chemotherapeutics, antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs)[ 15 , 16 ]. Risk factors also include age > 65 years[ 17 ], pre-existing chronic kidney disease (CKD), and comorbid diseases (such as diabetes and cardiovascular disease)[ 17 , 18 ], sepsis[ 16 ], contrast nephropathy[ 19 ], low blood volume, preoperative dehydration[ 20 - 22 ], low serum albumin levels[ 17 , 20 ], tumor size[ 23 ], anemia[ 20 ], heavy tumor burden or extensive metastasis, extensive surgery, surgical methods, intraoperative bleeding, operation time[ 17 , 24 - 28 ], and urinary tract obstruction[ 29 ] (Table 1 ).…”