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

• Published in: Annals of surgery Vol. 275; no. 5; p. e683
• Main Authors: Murphy, Conor F, Dunne, Talulla, Elliott, Jessie A, Kamarajah, Sivesh K, Leighton, James, Evans, Richard P T, Bundred, James, King, Sinead, Ravi, Narayanasamy, Donohoe, Claire L, Griffin, S Michael, Griffiths, Ewen A, Phillips, Alexander W, Reynolds, John V
• Format: Journal Article
• Language: English
• Published: United States 01.05.2022
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Esophageal Neoplasms - complications; Esophageal Neoplasms - surgery; Female; Humans; Incidence; Male; Middle Aged; Postoperative Complications - etiology; Retrospective Studies; Risk Factors
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000004146

To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer. 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. 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. 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. AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.