Inoue Yoshihiro, Suzuki Yusuke, Yokohama Keisuke, Ohama Hideko, Tsuchimoto Yusuke, Asai Akira, Fukunishi Shinya, Kimura Fumiharu, Higuchi Kazuhide, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College Mishima-Minami Hospital, Takatsuki City, Osaka, Japan.
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Takatsuki City, Osaka, Japan.
Contemp Oncol (Pozn). 2020;24(4):211-215. doi: 10.5114/wo.2020.102825. Epub 2021 Jan 4.
Patients with diabetes mellitus undergoing hepatectomy for hepatocellular carcinoma (HCC) are at high risk of acquiring perioperative infections. Herein, we investigate the peri-operative impact of diabetes on hepatectomy.
The surgical outcomes in 363 patients who underwent laparoscopic and open hepatic resection for HCC, with or without diabetes mellitus, were reviewed retrospectively. The association of diabetes mellitus with surgical outcomes and remnant liver regeneration was analyzed. The Student's and χ tests, Mann-Whitney's U test, Wilcoxon's signed-rank test, or Fisher's exact test were used in the statistical analysis.
Of the 363 patients, 136 (37.5%) had diabetes, while 227 (62.5%) did not. After propensity score matching, there were no significant differences between the groups in surgical outcomes such as surgery duration, bleeding amount, and postoperative complication rate. No significant differences were observed between the groups in terms of incidence rates of not only infectious complications, including surgical site infection and remote site infection, but also postoperative complication (Clavien-Dindo grade > IIIA), post-hepatectomy liver failure, and massive ascites. There were no differences in the remnant liver regeneration at 7 days and 1, 2, 5, and 12 months following the surgery between the groups ( = 0.076, 0.368, 0.864, 0.288, and 0.063, respectively). No significant differences between the groups in the overall and recurrence-free survival were observed ( = 0.613 and 0.937).
Remnant liver regeneration in diabetic patients was not morphologically and functionally delayed compared to that in non-diabetic patients. Moreover, diabetes has no effect on the short- and long-term prognosis.
因肝细胞癌（HCC）接受肝切除术的糖尿病患者发生围手术期感染的风险很高。在此，我们研究糖尿病对肝切除术的围手术期影响。
回顾性分析363例因HCC接受腹腔镜或开腹肝切除术的患者的手术结果，这些患者有或无糖尿病。分析糖尿病与手术结果及残余肝再生之间的关联。统计分析采用Student's检验和χ检验、Mann-Whitney U检验、Wilcoxon符号秩检验或Fisher精确检验。
363例患者中，136例（37.5%）患有糖尿病，227例（62.5%）无糖尿病。倾向评分匹配后，两组在手术持续时间、出血量和术后并发症发生率等手术结果方面无显著差异。两组在包括手术部位感染和远处感染在内的感染性并发症发生率、术后并发症（Clavien-Dindo分级>IIIA）、肝切除术后肝功能衰竭和大量腹水的发生率方面均无显著差异。两组术后7天、1个月、2个月、5个月和12个月时的残余肝再生情况无差异（分别为P = 0.076、0.368、0.864、0.288和0.063）。两组在总生存期和无复发生存期方面无显著差异（P = 0.613和0.937）。
与非糖尿病患者相比，糖尿病患者的残余肝再生在形态和功能上没有延迟。此外，糖尿病对短期和长期预后没有影响。
