title: Short-term and long-term outcomes after gastrectomy for gastric cancer in patients with chronic kidney disease.
abstract: BACKGROUND
  The incidence of chronic kidney disease (CKD) is increasing, which might be an obstacle to various aspects of gastric cancer treatment, such as perisurgical management and postsurgical follow-up. The present study aimed to evaluate the short- and long-term surgical outcomes following gastrectomy in patients with CKD.
  
  
  METHODS
  We retrospectively analyzed surgical complications and prognosis of patients with gastric cancer. These patients were divided into three groups according to the glomerular filtration rate (GFR): 49 patients with severe CKD (GFR < 29 ml/min/1.73 m(2)), 128 with mild CKD (GFR 30-59), and 798 in the controls (GFR ≥ 60).
  
  
  RESULTS
  The incidences of anastomotic leakage and intraabdominal abscess in the mild and severe CKD groups were higher than that in the control group. The incidences of wound infection, cardiovascular and pulmonary events, and in-hospital mortality in the severe CKD group were higher than those in the other two groups. Severe surgical complications were associated with co-morbidities other than CKD, serum albumin level, estimated blood loss, surgery duration in the mild and severe CKD group. The 3-year overall survival rates for the severe CKD, mild CKD, and control groups were 48.6, 80.9, and 85.0 %, respectively, indicating significant differences between the severe CKD group and other two groups.
  
  
  CONCLUSIONS
  Patients with severe CKD show an increased risk of morbidity and mortality following gastrectomy, and their prognosis is usually poor. Studies with a large cohort are essential to refine the risk stratification for gastrectomy in this high-risk population.
authors.affiliation: Department of Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan, msohei@naramed-u.ac.jp.
authors.forename: Sohei
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakatsuki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Migita
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D002423:Cause of Death; D016001:Confidence Intervals; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods / Q000401:mortality*; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome