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Minimally invasive esophagectomy may contribute to low incidence of postoperative surgical site infection in patients with poor glycemic control

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Abstract

Purpose

High preoperative hemoglobin A1c (HbA1c) levels have been suggested to increase complications after esophagectomy. Minimally invasive esophagectomy (MIE) is less invasive than open esophagectomy (OE) and may reduce postoperative complications. However, it has not been established whether MIE contributes to low morbidity in patients with high preoperative HbA1c levels. Thus, the current study aimed to elucidate the effect of preoperative HbA1c levels on the incidence of complications each after OE and MIE.

Methods

A total of 280 patients who underwent OE and 304 patients who underwent MIE for esophageal cancer between April 2005 and April 2020 were retrospectively analyzed. The OE and MIE groups were further divided into two groups according to their preoperative HbA1c levels (< 6.9%, ≥ 6.9%).

Results

Patients with high HbA1c levels had a significantly higher incidence of surgical site infections (SSIs) after OE (P = 0.0048). Multivariate analysis demonstrated that a high HbA1c level was an independent risk factor for frequent SSIs after OE (hazard ratio 2.52; 95% confidence interval, 1.101– 5.739; P = 0.029). On the contrary, a high HbA1c level did not affect the incidence of SSI after MIE (P = 1.00). A high HbA1c level was not associated with the incidence of morbidities other than SSI after OE and MIE.

Conclusions

A high preoperative HbA1c level significantly increased SSI risk after OE but not after MIE. It was suggested that lower invasiveness of MIE could contribute to a low incidence of SSI, even in patients with poor preoperative glycemic control.

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Acknowledgements

The authors thank all the people who contributed to this work.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Taishi Yamane, Naoya Yoshida, Tomo Horinouchi, Takeshi Morinaga, Kojiro Eto, Kazuto Harada, Katsuhiro Ogawa, Hiroshi Sawayama, Masaaki Iwatsuki, Yoshifumi Baba, Yuji Miyamoto & Hideo Baba

Authors
  1. Taishi Yamane
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  2. Naoya Yoshida
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  3. Tomo Horinouchi
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  4. Takeshi Morinaga
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  5. Kojiro Eto
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  6. Kazuto Harada
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  7. Katsuhiro Ogawa
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  8. Hiroshi Sawayama
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  9. Masaaki Iwatsuki
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  10. Yoshifumi Baba
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  11. Yuji Miyamoto
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  12. Hideo Baba
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Contributions

T. Yamane wrote the manuscript. N. Yoshida planned the study concept and design. T. Hoinouchi, T. Morinaga, K. Eto, K. Harada, and K. Ogawa collected the clinical data. H. Sawayama, M. Iwatsuki, Y. Baba, and Y. Miyamoto conducted critical revision of the manuscript. H. Baba coordinated the study and oversaw collection and analysis of the results. All authors discussed the data and commented on the manuscript.

Corresponding author

Correspondence to Hideo Baba.

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Ethics approval

This research was approved by the ethics committee in Kumamoto University Hospital.

Consent to participate

The ethics committee at our hospital admitted the present study procedure and waived the requirement for written informed consent (Registry Number 1909).

Conflict of interest

The authors declare no competing interests.

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Yamane, T., Yoshida, N., Horinouchi, T. et al. Minimally invasive esophagectomy may contribute to low incidence of postoperative surgical site infection in patients with poor glycemic control. Langenbecks Arch Surg 407, 579–585 (2022). https://doi.org/10.1007/s00423-021-02306-6

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  • DOI: https://doi.org/10.1007/s00423-021-02306-6

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