Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
Surg Today. 2023 Aug;53(8):907-916. doi: 10.1007/s00595-023-02641-9. Epub 2023 Jan 20.
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.
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.
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.
PBGV was associated with postoperative pneumonia, and low IPBG was an independent poor prognostic factor for patients with esophageal cancer.
本研究旨在描述接受食管癌切除术的患者术后血糖波动情况，并确定其对并发症和预后的影响。
本回顾性研究的对象为 2015 年至 2017 年在大阪大学医院接受食管癌切除术的 284 例患者。分析的数据包括临床病理背景、术后即刻血糖水平（IPBG）、术后血糖变异性（PBGV）、胰岛素用量、术后并发症和预后。
中位 IPBG 和 PBGV 分别为 170（64-260）mg/dl 和 64.5（11-217）mg/dl。PBGV>100mg/dl 的患者术后肺炎更常见（P=0.015）。IPBG<170mg/dl 的患者 5 年总生存率（OS）和 5 年无复发生存率（RFS）明显低于 IPBG>170mg/dl 的患者（分别为 54.5%和 80.4%，P<0.001和 44.3%和 69.3%，P=0.001）。IPBG<154mg/dl、154-170mg/dl、170-190mg/dl 和≥190mg/dl 的患者 5 年 OS 率分别为 43.5%、68.3%、80.6%和 79.0%，相应的 5 年 RFS 率分别为 38.1%、52.4%、77.0%和 61.3%。多因素分析显示，IPBG<154mg/dl 和病理分期是 OS 的独立不良预后因素。
PBGV 与术后肺炎有关，低 IPBG 是食管癌患者独立的不良预后因素。
