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Acute Kidney Injury After Esophageal Cancer Surgery: Incidence, Risk Factors, and Impact on Oncologic Outcomes

Lookup NU author(s): Professor Michael Griffin, Professor Alexander PhillipsORCiD

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Abstract

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. OBJECTIVE: To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer. SUMMARY OF BACKGROUND DATA: Esophageal cancer surgery is an exemplar of major operative trauma, with well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI. METHODS: consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 μmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI. RESULTS: A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m-2, and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age [P = 0.027, odds ratio (OR) 1.02 (1.00-1.04)], male sex [P = 0.015, OR 1.77 (1.10-2.81)], BMI at diagnosis [P < 0.001, OR 1.10 (1.07-1.14)], and dyslipidemia [P = 0.002, OR 2.14 (1.34-3.44)]. Postoperatively, AKI was associated with atrial fibrillation (P = 0.013) and pneumonia (P = 0.005). Postoperative AKI did not impact survival outcomes. CONCLUSION: AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.

Publication metadata

Author(s): Murphy CF, Dunne T, Elliott JA, Kamarajah SK, Leighton J, Evans RPT, Bundred J, King S, Ravi N, Donohoe CL, Griffin SM, Griffiths EA, Phillips AW, Reynolds JV

Publication type: Article

Publication status: Published

Journal: Annals of Surgery

Year: 2022

Volume: 275

Issue: 5

Pages: e683-e689

Print publication date: 01/05/2022

Acceptance date: 02/04/2018

ISSN (print): 0003-4932

ISSN (electronic): 1528-1140

Publisher: Lippincott Williams & Wilkins

URL: https://doi.org/10.1097/SLA.0000000000004146

DOI: 10.1097/SLA.0000000000004146

PubMed id: 32740248

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