Katsunobu Sakurai , Naoshi Kubo, Yutaka Tamamori, Naoki Aomatsu, Takafumi Nishii, Akiko Tachimori, Kiyoshi Maeda
Abstract
This study was undertaken to investigate the impact of coexisting chronic kidney disease (CKD) on short- and long-term outcomes of laparoscopic gastrectomy in patients with gastric cancer (GC).
Introduction
In East Asia, laparoscopic gastrectomy for gastric cancer (GC) is as safe and curative as open gastrectomy and has become the standard procedure for early GC [1, 2]. This procedure has been widely adopted for advanced cancer in recent years, with non-inferior outcomes compared to open gastrectomy [3, 4]. In addition, there have been several reports demonstrating that laparoscopic gastrectomy can be safely performed even in the elderly due to its minimally invasive nature [5, 6]. Thus, laparoscopic gastrectomy for GC is now an essential procedure for surgeons.
Japan has the highest aging rate worldwide, and the elderly population will continue to increase going forward [7, 8]. The elderly often have comorbidities, and the risk of operation and long-term outcomes differ depending on the severity of the comorbidities.
Method
Patients and clinical data collection
A total of 798 patients, who underwent laparoscopic gastrectomy for GC at Osaka City General Hospital (Osaka, Japan) between January 2010 and December 2017, were included in this study. Any patients subjected to prior gastrectomy were excluded. Clinicopathologic variables and postoperative complications were extracted from medical records, operative records, and pathology reports. For each patient, retrieval of baseline characteristics included age, gender, body mass index (BMI), serum albumin, comorbidities (diabetes mellitus or ischemic heart disease), tumor data (TNM stage), type of gastrectomy, operative time, recorded blood loss, harvested lymph node count, postoperative complications, and duration of postoperative hospital stay. Informed consent was obtained in the form of opt-out on the hospital’s web-site because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Discussion
In this study, CKD was closely associated with short-term outcomes in GC patients who underwent laparoscopic gastrectomy. Severe CKD (eGFR < 45) was a risk factor for major complications, in-hospital death, and longer hospital stays. In particular, severe CKD (eGFR < 45) emerged as an independent predictor of anastomotic leak. For long-term outcomes, the OS of patients was significantly worse for the severe CKD group than the other two groups; however, the CSS rate did not differ between groups.
Conclusion
Our results indicate that eGFR is a useful tool for predicting the risk of anastomotic leak and OS for GC patients undergoing laparoscopic gastrectomy. This parameter is informative for understanding the surgical risk and long-term outcomes of GC patients. Clinical care to improve eGFR should be reinforced at the time of GC treatment for GC patients with severe CKD.
Citation: Sakurai K, Kubo N, Tamamori Y, Aomatsu N, Nishii T, Tachimori A, et al. (2021) Impact of chronic kidney disease on the short- and long-term outcomes of laparoscopic gastrectomy for gastric cancer patients. PLoS ONE 16(4): e0250997. https://doi.org/10.1371/journal.pone.0250997
Editor: Fabio Sallustio, University of Bari: Universita degli Studi di Bari Aldo Moro, ITALY
Received: October 23, 2020; Accepted: April 18, 2021; Published: April 30, 2021
Copyright: © 2021 Sakurai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
