Postoperative acute renal failure in patients with gynecologic malignancies: analysis of 10 cases and review of the literature

Abstract

Objective: Postoperative acute renal failure (PO-ARF) is an important cause of mortality among surgical patients. Although there have been many reports on PO-ARF after cardiac surgery and liver transplantation, less is known about the risk of PO-ARF after gynecologic operations. We aimed to investigate the risk of PO-ARF on gynecologic malignancy operations. Methods: 1,155 patients' medical charts were reviewed who underwent therapeutic surgery for gynecologic malignancies from January 1, 2005 to December 31, 2007, at the Asan Medical Center, Seoul, Korea. Results: Of these, 10 patients, comprising 0.89% of those who underwent radical hysterectomies and 0.86% of those who underwent debulking operations, were diagnosed with PO-ARF. Their mean age was 61.9±10.1 years. Five patients had preoperative risk factors. Mean operating time was 360.8±96.2 minutes. Five patients experienced intra-operative hypotension and all patients were given blood transfusions during surgery. Eight patients underwent hemodialysis, with two continuing on dialysis to date. Only two patients fully recovered. Conclusion: Patients undergoing surgery for gynecologic malignancies may be at high risk for PO-ARF, because of old age, long operation times, and profuse bleeding. It is necessary to monitor these patients for postoperative renal function and urine output. If a postoperative oliguric state is detected, aggressive volume expansion should be started immediately, followed by hemodialysis.

Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies

“…This condition might be attributed to tachycardia due to preoperative hypovolemia because one of the most common causes of AKI is hypoperfusion due to volume depletion. Early diagnosis and treatment of hypovolemia are known to be highly effective in preventing AKI [ 1 ].…”

“…Brienza et al also reported that intraperitoneal surgery increases the risk of AKI [ 6 ]. Although gynecological surgeries are not highly risky, AKI can occur after extensive surgical excision such as radical hysterectomy and debulking [ 1 ]. In the KDIGO 2012 guidelines, major surgery is listed as a risk factor for AKI [ 19 ].…”

“…One of the complications is acute kidney injury (AKI) which affects the quality of life, leading to morbidity and mortality. Despite the renal treatment, the mortality associated with AKI is high because patients are generally elderly and weak due to comorbidities [ 1 ].…”

The 28-day survive for critically ill cancer patients undergoing continuous renal replacement with postoperative acute kidney injure: a retrospective study of 86 cases

“…Postoperative AKI (especially in need of RRT) is a major cause of shortterm mortality among surgical patients (8). There is few literature on the prognosis for critically ill cancer patients undergoing continuous renal replacement therapy (CRRT) with no-cardiac postoperative AKI (1,(9)(10)(11).…”

“…The ratio of male to female patients was 2.58:1. The median SOFA score was 6[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and the SAPS III was 65 [49-109].…”