Ann Surg Treat Res.  2023 Nov;105(5):281-289. 10.4174/astr.2023.105.5.281.

Real-world survival after colorectal surgery for malignancy in Korean patients with chronic kidney disease: an analysis of Korean healthcare big data, 2002–2019

• Song I
• Nam H
• Lee B
• Park BK
• Kim Jk
• Ryoo SB
• Park KJ
• Han EC

• KMID: 2547533
• DOI: http://doi.org/10.4174/astr.2023.105.5.281

Abstract

Purpose
Globally, chronic kidney disease (CKD) is common and has been associated with an increased risk of colorectal cancer (CRC). There is a dearth of literature on the real-world morbidity and mortality associated with CKD comorbid with CRC. This study was performed to evaluate real-world survival outcomes of colorectal malignancy in Korean CKD patients.
Methods
The National Health Insurance Service of Korea provided data on patients who underwent surgical resection among patients diagnosed with CRC from 2002 to 2019.
Results
A total of 219,550 patients were included: 6,181 patients with underlying CKD and 213,369 patients without it. Each morbidity was significantly higher in the CKD-CRC group, and the postoperative mortality rates for the 30-day (3.11% vs. 1.78%, P < 0.001), 60-day (5.95% vs. 3.83%, P < 0.001), and 90-day mortality rate (8.12% vs. 5.32%, P < 0.001) were significantly higher in the CKD group. The median survival time (MST, year) was significantly lower in the CKD-CRC group (5.63; interquartile range [IQR], 5.26–5.91) than in the non-CKD-CRC group (8.71; IQR, 8.37–8.93). MST was significantly lower among CKD patients who received chemotherapy after adjustment by multivariate analysis (adjusted hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.37–1.49; P < 0.001]). Subgroup analysis showed that in the CKD-CRC group, MST was lower in patients who received dialysis than in those who did not, even after multivariate analysis (adjusted HR, 2.38; 95% CI, 2.20–2.58; P < 0.001).
Conclusion
Prevention of CKD-to-end-stage renal disease progression should be adopted as a strategy to increase postoperative survival, along with active surveillance and cancer treatment.

Keyword

Chronic renal insufficiency; Colorectal neoplasms; Dialysis; Oncologic outcome; Survival

Figure

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  Fig. 1 Cohort flow chart. CKD, chronic kidney disease; ESRD, end-stage renal disease.

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  Fig. 2 Kaplan-Meir plots of overall survival according to chronic kidney disease (CKD) and colorectal cancer (CRC) status.

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  Fig. 3 Kaplan-Meir plots of overall survival according to whether or not they received dialysis. CRC, colorectal cancer; CKD, chronic kidney disease.

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