Does Chronic Kidney Disease Affect the Complications and Prognosis of Patients After Primary Colorectal Cancer Surgery?

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, = 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, < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, < 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, = 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, = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, < 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, < 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, = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, < 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.