Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1199-1209
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1199
Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?
Xiao-Yu Liu, Bin Zhang, Yu-Xi Cheng, Wei Tao, Chao Yuan, Zheng-Qiang Wei, Dong Peng
Xiao-Yu Liu, Bin Zhang, Yu-Xi Cheng, Wei Tao, Chao Yuan, Zheng-Qiang Wei, Dong Peng, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Liu XY and Bin Zhang are co-first authors; Liu XY and Zhang B contributed to data extraction; Peng D contributed to quality assessments and writing-origin draft; Peng D and Liu XY contributed to data analysis; Peng D, Liu XY, Zhang B, Cheng YX, Tao W, Yuan C, and Wei ZQ contributed to writing-review and editing; The final manuscript was read and approved by all of our authors.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Peng, PhD, Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yuanjia Gangyouyi Road, Chongqing 400016, China. carry_dong@126.com
Received: December 27, 2021
Peer-review started: December 27, 2021
First decision: March 13, 2022
Revised: March 26, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: June 15, 2022
Processing time: 164 Days and 8.7 Hours
Abstract
BACKGROUND

The effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.

AIM

To analyze whether CKD had specific effect on the outcomes after CRC surgery.

METHODS

We searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.

RESULTS

A total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.

CONCLUSION

Preexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.

Keywords: Chronic kidney disease; Colorectal cancer; Outcome; Prognosis; Meta-analysis

Core Tip: Previous studies have shown that patients with chronic kidney disease might have an increased risk of colorectal cancer, however, the impact of chronic kidney disease on complications and prognosis after colorectal cancer surgery is controversial. Furthermore, the prognosis remained unclear as well. Therefore, this study aimed to analyze whether chronic kidney disease had specific effect on the outcomes after colorectal cancer surgery. In conclusion, preexisting chronic kidney disease was associated with higher rates of pulmonary infection, higher rates of short-term death, poorer overall survival rates, and poorer disease-free survival rates following colorectal cancer surgery.