Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2025; 17(8): 105970
Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.105970
Retrospective review of anesthesia techniques and postoperative complications in patients with uremia undergoing colorectal cancer surgery
Xue-Jian Zheng, Zhi-Xiong Zhang, Jian Du
Xue-Jian Zheng, Department of Nephrology, Lanxi Traditional Chinese Medicine Hospital, Lanxi 321100, Zhejiang Province, China
Zhi-Xiong Zhang, Department of Anesthesiology, Tianjin Baodi Hospital, Tianjin Medical University Baodi Hospital, Tianjin 301800, China
Jian Du, Department of Anesthesia, Tianjin Beichen District Hospital of Traditional Chinese Medicine, Tianjin 300400, China
Co-first authors: Xue-Jian Zheng and Zhi-Xiong Zhang.
Author contributions: Zheng XJ and Zhang ZX contribute equally to this study as co-first authors; the concept of this study was jointly proposed by Zheng XJ and Du J, who participated in data collection; the initial manuscript was drafted by Zheng XJ; Du J and Zhang ZX contributed to the formal analysis of the data; Zheng XJ guided the research, methodology, and visualization of the manuscript; Zheng XJ, Du J, and Zhang ZX participated in this study and validated it by jointly reviewing and editing the manuscript.
Institutional review board statement: This research has been reviewed and approved by the Ethics Committee of Lanxi Hospital of Traditional Chinese Medicine.
Informed consent statement: This study obtained the informed consent of patients with traditional Chinese medicine in Lanxi City and they signed the relevant informed consent agreement.
Conflict-of-interest statement: The author declares that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No available data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Du, MD, Associate Chief Physician, Department of Anesthesia, Tianjin Beichen District Hospital of Traditional Chinese Medicine, No. 436 Jingjin Road, Beichen District, Tianjin 300400, China. dujian0871523@126.com
Received: April 25, 2025
Revised: May 21, 2025
Accepted: June 12, 2025
Published online: August 27, 2025
Processing time: 122 Days and 5.2 Hours
Abstract
BACKGROUND

Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.

AIM

To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.

METHODS

This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.

RESULTS

Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% vs 26.7%, P = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL vs 3100 mL, P < 0.001) and lower complication rates (19.5% vs 28.2%, P = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days vs 11 days; P < 0.001) and higher rates of major complications (27.8% vs 13.5%; P = 0.003).

CONCLUSION

In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.

Keywords: Patients with uremia; Postoperative complications; Total intravenous anesthesia; Goal-directed fluid therapy; Colorectal cancer surgery

Core Tip: This study evaluated the effects of anesthetic techniques and fluid management on postoperative complications in patients with uremia undergoing colorectal cancer surgery. These findings suggest that total intravenous anesthesia and goal-directed fluid therapy significantly reduce complication rates compared with those of inhalational anesthesia and standard fluid therapy. Advanced age, severe uremia, and excessive fluid balance were identified as key risk factors for complications. Optimizing anesthesia and fluid strategies may improve postoperative outcomes and reduce hospital stays in this high-risk population.