Outcomes of endoscopic submucosal dissection for gastric epithelial neoplasm in chronic kidney disease patients: propensity score-matched case–control analysis
| Autor: | Hee Kyong Na, Ji Yong Ahn, Gin Hyug Lee, Young Kwon Choi, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Hwoon-Yong Jung, Kee Don Choi, Ho June Song |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Endoscopic Mucosal Resection Perforation (oil well) Subgroup analysis Kaplan-Meier Estimate urologic and male genital diseases Gastroenterology 03 medical and health sciences 0302 clinical medicine Stomach Neoplasms Surgical oncology Internal medicine Humans Medicine Renal Insufficiency Chronic Stage (cooking) Propensity Score Retrospective Studies business.industry Carcinoma General Medicine Middle Aged medicine.disease female genital diseases and pregnancy complications Treatment Outcome Oncology Case-Control Studies 030220 oncology & carcinogenesis Propensity score matching Female 030211 gastroenterology & hepatology business Gastric Neoplasm Abdominal surgery Kidney disease |
| Zdroj: | Gastric Cancer. 22:164-171 |
| ISSN: | 1436-3305 1436-3291 |
| Popis: | Little is known about the outcomes of gastric endoscopic submucosal dissection (ESD) in patients with chronic kidney disease (CKD). We compared the efficacy and safety of ESD between CKD and non-CKD patients. From January 2005 to December 2014, 102 CKD patients underwent ESD for gastric neoplasms at a tertiary medical institution were reviewed retrospectively. A propensity score-matched control group (102 patients) was selected from non-CKD patients to compare clinical outcomes between CKD and non-CKD patients. En bloc resection (96.1%) and curative resection (88.2%) rates in the CKD group did not significantly differ from those in the non-CKD group. Median procedure times (25.0 vs. 21.5 min, p = 0.734) and perforation risk (p = 0.480) were similar between groups. The CKD group showed a tendency towards more bleeding events (p = 0.052) and had a significantly longer hospital stay (p = 0.001). In a subgroup analysis, stage 3 CKD patients exhibited a bleeding risk comparable to that exhibited by non-CKD patients (HR 1.35; 95% CI 0.36–5.06; p = 0.654), whereas stage 4 (HR 5.79; 95% CI 1.52–22.0; p = 0.010) and stage 5 (HR 4.80; 95% CI 1.58–14.6; p = 0.006) patients showed higher bleeding risks than non-CKD patients. In a multivariate analysis, stage 4/5 CKD was a significant predictor for bleeding risk (HR 4.99; 95% CI 1.32–18.8; p = 0.018). ESD for gastric epithelial neoplasms can be performed in stage 3 CKD patients with comparable efficacy and safety to that performed in non-CKD patients. Stage 4 and 5 CKD patients should be closely monitored for bleeding events after ESD. |
| Databáze: | OpenAIRE |
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