Evaluation of renal tubular damage in laparoscopic colon surgery with KIM-1 molecule

Aim: Colon cancer is the third most common type of cancer in men and women in our country. With the development of technology over time, minimally invasive treatment options have come to the fore.The aim of this study was to compare the intra-abdominal pressure created in laparoscopic colon surgery with open procedures using the KIM-1 molecule secreted from the renal tubules, which is the most sensitive response to damage to the kidney. Material and Method: In our study, a total of 46 patients who applied to the general surgery clinic of our hospital between November 2021 and April 2022 and were diagnosed with colon cancer and operated with laparoscopic and open procedures were included.The patients were randomized prospectively to undergo 10 laparoscopic right hemicolectomy (Group 1), 8 open right hemicolectomy (Group 2), 8 laparoscopic anterior resection (Group 3), 11 open anterior resection (Group 4), and 9 laparoscopic low anterior resection (Group 5).divided into five groups.Urine KIM-1 levels were measured by taking urine samples from the patients on the preoperative, postoperative 4th hour and postoperative 14th day.Then, urine KIM-1/Cr ratios were calculated.The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results: 50.0% (n=23) of the operated patients were male and 50.0% (n=23) were female.The mean age of the patients was 61.65±11.94 years, and the mean BMI was 26.26±5.34 kg/m2.Laparoscopic surgery was performed in 58.7% (n=27) of the patients included in the study.Intra-abdominal pressure was determined as 12 mmHg in each patient who underwent laparoscopic surgery.Age, preoperative KIM-1/Cr, postoperative 4th hour and postoperative 14th day urinary KIM-1/Cr levels, operation durations and gender ratios were found to be similar in open surgery and laparoscopic surgery patient groups (p>0.05).In the patients who underwent laparoscopic surgery included in the study, it was found that there was a positive low-moderate correlation between the KIM-1/Cr level measured in the preoperative urine and the patient's age, and a moderate positive correlation between the KIM-1/Cr level measured in the urine at the postoperative 4th hour and the patient's age.(r values, respectively; r=0.365, r=0.477, p values, respectively; p=0.047, p=0.008).The KIM-1/Cr levels measured in the urine of the patients who underwent LAR operation on the postoperative 14th day were found to be statistically significantly higher than the patient groups who underwent other laparoscopic operations (p=0.022).A positive and statistically significant correlation was found between the KIM-1/Cr level measured in the urine at the postoperative 4th hour and the duration of the operation in patients who underwent LSH operation (r=0.673, p=0.033) (Table 5).The KIM-1/Cr level studied in the preoperative urine was found to be statistically significantly lower in patients undergoing LLAR compared to patients undergoing SH, AR, LSH and LAR (p=0.022).Postoperative 14th day KIM-1/Cr level was found to be statistically significantly higher in patients who had LAR compared to patients who had undergone SH, AR, LSH and LLAR (p=0.038). Conclusion: As a result of our study, KIM-1/Cr levels in the urine were increased at the post-operative 4th hour in surgeries performed with open procedure and laparoscopic procedure.On the post-operative 14th day, lower urinary KIM-1/Cr levels were observed in the other groups than in the pre-operative period, except for LAR.The high urine KIM-1/Cr value in the LAR group suggests that the urine KIM-1/Cr value was found to be high in the preoperative period of the patients, suggesting that it may be related to underlying renal pathologies.Except for these patients, urine KIM-1/Cr values were similar in all groups, and we did not find statistical significance between the 5 groups. Key Words: Laparoscopic Colon Surgery, Renal Tubuler Damage, KIM-1