The Clinical Outcomes of Surgical Resection for Primary Colorectal Cancer Patients with End Stage Renal Disease

原發型大腸直腸癌合併末期腎臟疾病的病人在手術切除後的臨床結果

蔡達基(Tak-Kee Choy) ； 馬政仁(Cheng-Jen Ma) ； 黃敬文(Ching-Wen Huang) ； 陳芳銘(Fang-Ming Chen) ； 莊捷翰(Chieh-Han Chuang) ； 陳漢文(Hon-Man Chan) ； 黃哲人(Che-Jen Huang) ； 王照元(Jaw-Yuan Wang)

《中華民國大腸直腸外科醫學會雜誌》 26卷1期 (2015/03) Pp. 8-13

https://doi.org/10.6312/SCRSTW.2015.26(1).10323

摘要

目的　慢性腎衰竭是一個影響全世界的主要健康問題，尤其是末期腎臟疾病，對於大腸直腸癌的病人在手術切除以後或許是一個障礙。這個研究的主要目的就是要評估大腸直腸癌合併末期腎臟疾病的病人在手術切除以後的臨床結果。病人和方法　從2008至2013年間，我們回顧性分析了29個經過手術切除的直腸癌合併末期腎臟疾病的病人，這些病人都經過完整的病歷審查。結果　這些病人中，主要是男性病人（65%），平均年齡是70歲（範圍53-88）。合併症的機率相當高，其中高血壓72%，糖尿病45%和心臟血管疾病31%。最常見的位置是乙狀結腸。發生在大腸直腸癌合併末期腎臟疾病組的術後併發症（34%）比非末期腎臟疾病的大腸直腸癌組（16%，p=0.008）來的高。術後心臟血管疾併發症在大腸直腸癌合併末期腎臟疾病組（10.5%）也比非末期腎臟疾病的大腸直腸癌組（1.8%，p=0.002）來的高。大腸直腸癌合併末期腎臟疾病組的其它併發症如吻合處滲漏，手術傷口感染，腸皮膚廔管，腸阻塞，出血，腦血管疾病等等，這些併發症佔了3.5%-7%的發生率。這些經過手術切除的直腸癌合併末期腎臟疾病的病人，其5年存活率分別為第1年（86%），第2年（66%），第3年（53%），第4年（24%）以及第5年（24%）。結論　從這些結果來看，我們總結了大腸直腸癌合併末期腎臟疾病的病人在經過了手術切除以後，術後併發症的高發生率要有警覺心，外科醫師必須牢記這個議題。

關鍵字

大腸直腸癌 ； 慢性腎衰竭 ； 末期腎臟疾病 ； 臨床結果

並列摘要

Purpose. Chronic kidney disease is a major health problem affecting populations worldwide, especially end- stage renal disease, may be an obstacle for colorectal cancer patients after surgical resection. The aim of the current study was to evaluate the clinical outcomes of patients with colorectal cancer who have end- stage renal disease following surgical resection. Patients and Method. We retrospectively analyzed 29 colorectal cancer patients with end- stage renal disease who underwent surgical resection between 2008 and 2013, of which the complete medical record of these patients was reviewed. Results. They were predominantly male patients (65%) and the median age was 70 years (range 53-88). The incidence of comorbid illness was relatively high, such as hypertension (72%), diabetes mellitus (45%), and cardiovascular disease (31%). The most frequent location of primary tumor was sigmoid colon. The complication rates were higher in end- stage renal disease group (34%) than non end- stage renal disease group (16%, p=0.008). Postoperative cardiovascular complication in end- stage renal disease group (10.5%) was higher than non end- stage renal disease group (1.8%, p=0.002). The others complications such as anastomotic leakage, surgical wound infection, enterocutaneous fistula, ileus, bleeding and cerebrovascular accident occurred in 3.5% to 7% of studied in end- stage renal disease group. The five-year overall survival demonstrated 1-year was 86%, 2-years was 66%, 3-years was 53%, 4-years was 24% and 5-years was 24%. Conclusions. From the present results, we concluded that colorectal cancer patients with end- stage renal disease who underwent surgical resection must be aware of the significantly high incidence of postoperative adverse events, especially cardiovascular complications, and clinicians should keep this issue in mind.

並列關鍵字

Colorectal cancer ； Chronic kidney disease ； End-stage renal disease ； Clinical outcomes

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