Lorenzo Aldenb, Goltsman David, Apostolou Christos, Das Amitabha, Merrett Neil
Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, AUS.
General Surgery, Royal Australasian College of Surgeons, Melbourne, AUS.
Cureus. 2022 Jan 24;14(1):e21559. doi: 10.7759/cureus.21559. eCollection 2022 Jan.
Diabetes is a recognised risk for several chronic and acute illnesses, including increased complications in surgery for oesophageal cancer. Our primary aim is to determine the impact of diabetes on postoperative surgical and medical complications after oesophagectomy.
All oesophagectomies for malignancy as reflected in the 2016-2018 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) datasets were extracted and analysed. Current Procedural Terminology (CPT) codes used were 1) open procedures (43107, 43108, 43112, 43113, 43116, 43117, 43118, 43121, 43122, and 43123) and 2) hybrid procedures (43186, 43287, and 43288). Logistic regression models examined associations between diabetic status and adverse outcomes. The associations were adjusted for sex, race, age group, operation year, CPT code, body mass index (BMI), smoking, congestive heart failure, antihypertensives, renal failure, and dyspnoea.
Two thousand five hundred and thirty-eight oesophagectomies were identified. 86.45% (n=2,194) underwent open procedures and 13.55% (n=344) had hybrid procedures. There were 177 insulin-dependent diabetics (IDDM) and 320 (12.61%) non-insulin-dependent diabetics (NIDDM). 84.14% were male and 77.74% were Caucasian. 89.48% of the patients were between 50 and 79 years of age. 40.27% experienced postoperative complications. Medical complications (odds ratio [OR]: 1.7, p-value: 0.002), surgical complications (OR: 1.9, p-value: <0.001), wound complications (OR: 2.9, p-value: <0.001), and anastomotic leaks (OR: 2.4, p-value: <0.001) were more common in diabetic patients. Subgroup analysis showed that in hybrid procedures, there is a statistically significant increase in the OR of surgical complications (OR: 3.61, p-value: 0.05), medical complications (OR: 3.76, p-value: 0.04), and anastomotic leak (OR: 3.49, p-value: 0.27) in IDDM as compared to NIDDM.
Insulin-dependent diabetes doubles the risk of all major complications compared to nondiabetics. When considering surgical approach and diabetic status (IDDM vs nondiabetics, NIDDM vs nondiabetics), the risk of complications further doubles for hybrid oesophagectomies compared to open procedures.
糖尿病是多种慢性和急性疾病的公认风险因素，包括食管癌手术中并发症增加。我们的主要目的是确定糖尿病对食管癌切除术后手术和医疗并发症的影响。
提取并分析2016 - 2018年美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据集中所有因恶性肿瘤进行的食管癌切除术。使用的当前手术操作术语（CPT）代码为：1）开放手术（43107、43108、43112、43113、43116、43117、43118、43121、43122和43123）以及2）混合手术（43186、43287和43288）。逻辑回归模型检验糖尿病状态与不良结局之间的关联。这些关联针对性别、种族、年龄组、手术年份、CPT代码、体重指数（BMI）、吸烟、充血性心力衰竭、抗高血压药、肾衰竭和呼吸困难进行了调整。
共识别出2538例食管癌切除术。86.45%（n = 2194）接受开放手术，13.55%（n = 344）进行混合手术。有177例胰岛素依赖型糖尿病患者（IDDM）和320例（12.61%）非胰岛素依赖型糖尿病患者（NIDDM）。84.14%为男性，77.74%为白种人。89.48%的患者年龄在50至79岁之间。40.27%的患者出现术后并发症。糖尿病患者中医疗并发症（优势比[OR]：1.7，p值：0.002）、手术并发症（OR：1.9，p值：<0.001）、伤口并发症（OR：2.9，p值：<0.001）和吻合口漏（OR：2.4，p值：<0.001）更为常见。亚组分析显示，在混合手术中，与NIDDM相比，IDDM患者手术并发症（OR：3.61，p值：0.05）、医疗并发症（OR：3.76，p值：0.04）和吻合口漏（OR：3.49，p值：0.27）的OR在统计学上有显著增加。
与非糖尿病患者相比，胰岛素依赖型糖尿病使所有主要并发症的风险加倍。在考虑手术方式和糖尿病状态（IDDM与非糖尿病患者、NIDDM与非糖尿病患者）时，与开放手术相比，混合食管癌切除术的并发症风险进一步加倍。
