J Gastric Cancer.  2018 Sep;18(3):287-295. 10.5230/jgc.2018.18.e31.

Safety of Laparoscopic Radical Gastrectomy in Gastric Cancer Patients with End-Stage Renal Disease

• Lee H
• Park CH
• Park SM
• Kim W
• Chin HM
• Kim JJ
• Song KY
• Kim SG
• Jun KH
• Kim JG
• Lee HH
• Lee J
• Kim DJ

• KMID: 2420788
• DOI: http://doi.org/10.5230/jgc.2018.18.e31

Abstract

PURPOSE
The surgical outcomes of end-stage renal disease (ESRD) patients undergoing radical gastrectomy for gastric cancer were inferior compared with those of non-ESRD patients. This study aimed to evaluate the short- and long-term surgical outcomes of ESRD patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer.
MATERIALS AND METHODS
Between 2004 and 2014, 38 patients (OG: 21 patients, LG: 17 patients) with ESRD underwent gastrectomy for gastric cancer. Comparisons were made based on the clinicopathological characteristics, surgical outcomes, and long-term survival rates.
RESULTS
No significant differences were noted in the clinicopathological characteristics of either group. LG patients had lower estimated blood loss volumes than OG patients (LG vs. OG: 94 vs. 275 mL, P=0.005). The operation time and postoperative hospital stay were similar in both the groups. The postoperative morbidity for LG and OG patients was 41.1% and 33.3%, respectively (P=0.873). No significant difference was observed in the long-term overall survival rates between the 2 groups (5-year overall survival, LG vs. OG: 82.4% vs. 64.7%, P=0.947).
CONCLUSIONS
In ESRD patients, LG yielded non-inferior short- and long-term surgical outcomes compared to OG. Laparoscopic procedures might be safely adopted for ESRD patients who can benefit from the advantages of minimally invasive surgery.

Keyword

Stomach neoplasms; Gastrectomy; Laparoscopy; Kidney failure

MeSH Terms

Gastrectomy*
Humans
Kidney Failure, Chronic*
Laparoscopy
Length of Stay
Minimally Invasive Surgical Procedures
Renal Insufficiency
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 No difference in the overall survival between LG and OG was detected. LG = laparoscopic gastrectomy; OG = open gastrectomy.

Reference

1. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Prediction of cancer incidence and mortality in Korea, 2014. Cancer Res Treat. 2014; 46:124–130.

2. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat. 2014; 46:109–123.

3. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, et al. Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol. 2014; 32:627–633.

4. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008; 248:721–727.

5. Borlase B, Simon JS, Hermann G. Abdominal surgery in patients undergoing chronic hemodialysis. Surgery. 1987; 102:15–18.

6. Wind P, Douard R, Rouzier R, Berger A, Bony C, Cugnenc PH. Abdominal surgery in chronic hemodialysis patients. Am Surg. 1999; 65:347–351.

7. Toh Y, Yano K, Takesue F, Korenaga D, Maekawa S, Muto Y, et al. Abdominal surgery for patients on maintenance hemodialysis. Surg Today. 1998; 28:268–272.

8. Devbhandari MP, Duncan AJ, Grayson AD, Fabri BM, Keenan DJ, Bridgewater B, et al. Effect of risk-adjusted, non-dialysis-dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multi-centre study. Eur J Cardiothorac Surg. 2006; 29:964–970.

9. Cooper WA, O'Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the society of thoracic surgeons national adult cardiac database. Circulation. 2006; 113:1063–1070.

10. Cloyd JM, Ma Y, Morton JM, Kurella Tamura M, Poultsides GA, Visser BC. Does chronic kidney disease affect outcomes after major abdominal surgery? results from the national surgical quality improvement program. J Gastrointest Surg. 2014; 18:605–612.

11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–383.

12. Malenka DJ, McLerran D, Roos N, Fisher ES, Wennberg JE. Using administrative data to describe casemix: a comparison with the medical record. J Clin Epidemiol. 1994; 47:1027–1032.

13. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173:676–682.

14. Sano T, Kodera Y. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112.

15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187–196.

16. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013; 258:1–7.

17. Iannuzzi JC, Deeb AP, Rickles AS, Sharma A, Fleming FJ, Monson JR. Recognizing risk: bowel resection in the chronic renal failure population. J Gastrointest Surg. 2013; 17:188–194.

18. Matsumoto S, Takayama T, Wakatsuki K, Tanaka T, Migita K, Nakajima Y. Short-term and long-term outcomes after gastrectomy for gastric cancer in patients with chronic kidney disease. World J Surg. 2014; 38:1453–1460.

19. Wakahara T, Ueno N, Komatsu S, Ashitani H, Tsuchida S, Toyokawa A. Outcome of gastric cancer surgery in patients with chronic kidney disease. Dig Surg. 2017; 34:241–246.

20. Liu YY, Tsai CY, Yeh CN, Chiang KC, Wang SY, Cheng CT, et al. Gastric cancer patients with end-stage renal disease who underwent radical gastrectomy. Anticancer Res. 2015; 35:2263–2268.

21. Craig RG, Hunter JM. Recent developments in the perioperative management of adult patients with chronic kidney disease. Br J Anaesth. 2008; 101:296–310.

22. Acedillo RR, Shah M, Devereaux PJ, Li L, Iansavichus AV, Walsh M, et al. The risk of perioperative bleeding in patients with chronic kidney disease: a systematic review and meta-analysis. Ann Surg. 2013; 258:901–913.

23. Mari G, Scanziani R, Auricchio S, Crippa J, Maggioni D. Laparoscopic surgery in patients on peritoneal dialysis: a review of the literature. Surg Innov. 2017; 24:397–401.

24. van Walraven C, Manuel DG, Knoll G. Survival trends in ESRD patients compared with the general population in the United States. Am J Kidney Dis. 2014; 63:491–499.