The Impact of Anesthesia and Surgical Intervention on Liver and Kidney Function in Patients With Gynecological Malignancies

AIM: Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes. METHODS: This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes. RESULTS: Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT (p = 0.044), AST (p < 0.001), TBIL (p < 0.001), creatinine (p = 0.026), and urea (p < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all p < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, p < 0.001), with significant postoperative decreases in red blood cell (RBC) count (p < 0.001), hemoglobin (Hb) levels (p < 0.001), and platelet count (p = 0.003), alongside a substantial increase in white blood cell (WBC) count (p < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT (p = 0.001), AST (p < 0.001), TBIL (p < 0.001), and urea (p = 0.002) levels; however, its association with creatinine levels did not reach statistical significance (p > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine (p = 0.002) and urea (p = 0.015) levels and TBIL (p = 0.002), whereas no significant effects were observed on ALT or AST (p > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST (p = 0.015), TBIL (p = 0.018), and urea levels (p < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST (p = 0.002), TBIL (p = 0.003), and urea levels (p = 0.003), while its associations with ALT (p = 0.083) and creatinine (p = 0.089) were not significant. Notably, pathological grade (G3 vs. G1), mode of anesthesia (general vs. local anesthesia), and age were not significantly associated with these biomarkers (p > 0.05). Furthermore, survival analysis revealed significantly reduced 5-year survival in patients with hepatorenal dysfunction, with survival curves diverging markedly from 32 months post-surgery (p < 0.001). CONCLUSIONS: Perioperative hepatorenal injury in gynecological malignancies is independently associated with tumor stage, open surgery, prolonged operative time, intraoperative blood loss, and tumor biology, and it critically impacts long-term survival. Therefore, minimally invasive techniques and optimizing perioperative management are essential to reduce organ damage and improve patient outcomes.