Prognostic Implications of Chronic Kidney Disease in Colorectal Cancer Surgery: A Propensity Score‐Matched Analysis

BACKGROUND: Chronic kidney disease (CKD) is a common comorbidity that may impact surgical outcomes in colorectal cancer (CRC). OBJECTIVE: This study evaluated the prognostic significance of CKD on postoperative complications and survival in CRC patients undergoing curative surgery. METHODS: This retrospective cohort study included 510 patients with stage I-III CRC who underwent surgery between 2011 and 2023. Patients were categorized into CKD (n = 32, 81.3% had end-stage renal disease) and non-CKD (n = 478) groups. Propensity score matching (PSM) was performed to adjust for confounders. Short-term outcomes, including postoperative morbidity, in-hospital mortality, and hospital stay, were analyzed alongside long-term survival. RESULTS: Patients with CKD exhibited significantly higher rates of surgical site infections (p = 0.031), intra-abdominal abscesses (p = 0.047), pulmonary thromboembolism (p = 0.021), and stroke (p = 0.003). CKD was associated with an increased risk of severe complications (50% vs. 17.2%, p < 0.001) and higher in-hospital mortality (18.8% vs. 0.8%, p < 0.001). After PSM, in-hospital mortality (p = 0.024) and Clavien-Dindo grade ≥ 3 morbidity (p = 0.001) remained significantly higher in CKD patients. CKD did not impact disease-free survival, but it was independently associated with mortality (HR: 3.262, 95% CI: 1.535-6.930, p = 0.002) CONCLUSIONS: CKD, particularly in dialysis-dependent patients, significantly increases postoperative morbidity and mortality following CRC surgery. Although oncologically appropriate surgery is feasible in CKD patients, their reduced OS underscores the need for meticulous perioperative management and individualized treatment strategies.