Abstract
Purpose
This study aimed to characterize postoperative blood glucose fluctuation in patients who underwent esophagectomy for esophageal cancer, and to define its impact on complications and prognosis.
Methods
The subjects of this retrospective study were 284 patients who underwent esophagectomy at Osaka University Hospital between 2015 and 2017. Data analyzed included clinicopathological background, the immediate postoperative blood glucose level (IPBG), postoperative blood glucose variability (PBGV), insulin dosage, postoperative complications, and prognosis.
Results
The median IPBG and PBGV were 170 (64–260) mg/dl and 64.5 (11–217) mg/dl, respectively. Postoperative pneumonia was more common in patients with PBGV > 100 mg/dl (P = 0.015). Patients with IPBG < 170 mg/dl had significantly worse 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) than those with IPBG > 170 mg/dl (54.5% vs. 80.4%, respectively, [P < 0.001] and 44.3% vs. 69.3%, respectively, [P = 0.001]). The 5-year OS rates were 43.5%, 68.3%, 80.6%, and 79.0% for patients with IPBG < 154, 154–170, 170–190, and ≥ 190 mg/dl, respectively. The corresponding 5-year RFS rates were 38.1%, 52.4%, 77.0%, and 61.3%, respectively. Multivariate analysis revealed that IPBG < 154 mg/dl and pathological stage were independent poor prognostic factors for OS.
Conclusion
PBGV was associated with postoperative pneumonia, and low IPBG was an independent poor prognostic factor for patients with esophageal cancer.
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References
Koumpan Y, VanDenKerkhof E, van Vlymen J. An observational cohort study to assess glycosylated hemoglobin screening for elective surgical patients. Can J Anaesth. 2014;61:407–16.
Goodenough CJ, Liang MK, Nguyen MT, Nguyen DH, Holihan JL, Alawadi ZM, et al. Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery. J Am Coll Surg. 2015;221:854–61.
Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care. 2010;33:1783–8.
Tennyson C, Lee R, Attia R. Is there a role for HbA1c in predicting mortality and morbidity outcomes after coronary artery bypass graft surgery? Interact Cardiovasc Thorac Surg. 2013;17:1000–8.
Okamura A, Watanabe M, Imamura Y, Kamiya S, Yamashita K, Kurogochi T, et al. Preoperative glycosylated hemoglobin levels predict anastomotic leak after esophagectomy with cervical esophagogastric anastomosis. World J Surg. 2017;41:200–7.
Yamashita K, Makino T, Miyata H, Miyazaki Y, Takahashi T, Kurokawa Y, et al. Postoperative infectious complications are associated with adverse oncologic outcomes in esophageal cancer patients undergoing preoperative chemotherapy. Ann Surg Oncol. 2016;23:2106–14.
Yamashita K, Watanabe M, Mine S, Fukudome I, Okamura A, Yuda M, et al. The impact of the Charlson comorbidity index on the prognosis of esophageal cancer patients who underwent esophagectomy with curative intent. Surg Today. 2018;48:632–9.
Shiozaki H, Yano M, Tsujinaka T, Inoue M, Tamura S, Doki Y, et al. Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus. 2001;14:191–6.
Yamashita K, Makino T, Yamasaki M, Tanaka K, Hara T, Miyazaki Y, et al. Comparison of short-term outcomes between 2- and 3-field lymph node dissection for esophageal cancer. Dis Esophagus. 2017;30:1–8.
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.
Shibata C, Ogawa H, Nakano T, Koyama K, Yamamoto K, Nagao M, et al. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg. 2019;19:106.
Trinh VQ, Ravi P, Abd-El-Barr AE, Jhaveri JK, Gervais MK, Meyer CP, et al. Pneumonia after major cancer surgery: temporal trends and patterns of care. Can Respir J. 2016;2016:6019416.
Jung J, Moon SM, Jang HC, Kang CI, Jun JB, Cho YK, et al. Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of “Cancer POP” study. Cancer Med. 2018;7:261–9.
Strobel RJ, Liang Q, Zhang M, Wu X, Rogers MA, Theurer PF, et al. A preoperative risk model for postoperative pneumonia after coronary artery bypass grafting. Ann Thorac Surg. 2016;102:1213–9.
Windsor JA, Hill GL. Weight loss with physiologic impairment a basic indicator of surgical risk. Ann Surg. 1988;207:290–6.
Lopez-de-Andres A, Perez-Farinos N, de Miguel-Diez J, Hernandez-Barrera V, Jimenez-Trujillo I, Mendez-Bailon M, et al. Type 2 diabetes and postoperative pneumonia: an observational, population-based study using the Spanish hospital discharge database, 2001–2015. PLoS ONE. 2019;14: e0211230.
Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993;17:357–68.
Azizzadeh A, Sanchez LA, Miller CC 3rd, Marine L, Rubin BG, Safi HJ, et al. Glomerular filtration rate is a predictor of mortality after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2006;43:14–8.
Shaw P, Saleem T, Gahtan V. Correlation of hemoglobin A1C level with surgical outcomes: can tight perioperative glucose control reduce infection and cardiac events? Semin Vasc Surg. 2014;27:156–61.
Jafar N, Edriss H, Nugent K. The effect of short-term hyperglycemia on the innate immune system. Am J Med Sci. 2016;351:201–11.
Peila R, Rohan TE. Diabetes, glycated hemoglobin, and risk of cancer in the Uk Biobank study. Cancer Epidemiol Biomarkers Prev. 2020;29:1107–19.
Zhang L, Su Y, Chen Z, Wei Z, Han W, Xu A. The prognostic value of preoperative inflammation-based prognostic scores and nutritional status for overall survival in resected patients with nonmetastatic Siewert type II/III adenocarcinoma of esophagogastric junction. Medicine (Baltimore). 2017;96: e7647.
Kochi R, Suzuki T, Yajima S, Oshima Y, Ito M, Funahashi K, et al. Does preoperative low HbA1c predict esophageal cancer outcomes? Ann Thorac Cardiovasc Surg. 2020;26:184–9.
Moorthy V, Sim MA, Liu W, Chew STH, Ti LK. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study. Medicine (Baltimore). 2019;98: e15911.
van Vulpen JK, Siersema PD, van Hillegersberg R, Nieuwenhuijzen GAP, Kouwenhoven EA, Groenendijk RPR, et al. Physical exercise following esophageal cancer treatment (PERFECT) study: design of a randomized controlled trial. BMC Cancer. 2017;17:552.
Szymanska E, Jozwiak-Dziecielewska DA, Gronek J, Niewczas M, Czarny W, Rokicki D, et al. Hepatic glycogen storage diseases: pathogenesis, clinical symptoms and therapeutic management. Arch Med Sci. 2021;17:304–13.
Puhr HC, Wolf P, Berghoff AS, Schoppmann SF, Preusser M, Ilhan-Mutlu A. Elevated free thyroxine levels are associated with poorer overall survival in patients with gastroesophageal cancer: a retrospective single center analysis. Horm Cancer. 2020;11:42–51.
Zeitzer JM, Nouriani B, Rissling MB, Sledge GW, Kaplan KA, Aasly L, et al. Aberrant nocturnal cortisol and disease progression in women with breast cancer. Breast Cancer Res Treat. 2016;158:43–50.
Jiang HC, Chen XR, Sun HF, Nie YW. Tumor promoting effects of glucagon receptor: a promising biomarker of papillary thyroid carcinoma via regulating EMT and P38/ERK pathways. Hum Cell. 2020;33:175–84.
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Koga, C., Yamashita, K., Yukawa, Y. et al. The impact of postoperative blood glucose levels on complications and prognosis after esophagectomy in patients with esophageal cancer. Surg Today 53, 907–916 (2023). https://doi.org/10.1007/s00595-023-02641-9
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DOI: https://doi.org/10.1007/s00595-023-02641-9