Li Shuaichao, Gao Zhengjie, Fan Longxin, Meng Tao, Chen Binghe
Department of General Surgery, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui City, Xinxiang City, 453100, Henan Province, China.
Sci Rep. 2025 Jul 16;15(1):25832. doi: 10.1038/s41598-025-11462-4.
Insulin resistance and stress response are relatively prevalent among patients with colorectal cancer before surgery. This study aimed to explore the effects of these two disorders on the risk of anastomotic leakage after colorectal cancer surgery. Briefly, 503 patients with this type of cancer scheduled for surgery were enrolled. The study used the HOMA-IR to evaluate the patients' preoperative insulin resistance, collected blood samples to detect the preoperative levels of adrenaline and cortisol, and also adopted the State-Trait Anxiety Inventory and the Impact of Event Scale to assess the patients' psychological stress status. After performing the surgery, the study monitored the onset of anastomotic leakage within one month. Multivariable logistic regression was used for data analysis. The results suggested that preoperative insulin resistance, elevation of the two hormone levels, and increased psychological stress scores were significantly associated with an increased risk of anastomotic leakage. When the levels of adrenaline and cortisol increased by one standard deviation, the increase in the risk of this postoperative complication was greater in patients with insulin resistance than in those without insulin resistance. In conclusion, both preoperative insulin resistance and stress response were potential risk factors for anastomotic leakage after colorectal cancer surgery.
胰岛素抵抗和应激反应在结直肠癌患者术前相对普遍。本研究旨在探讨这两种紊乱对结直肠癌手术后吻合口漏风险的影响。简而言之，纳入了503例计划进行手术的此类癌症患者。该研究使用稳态模型评估法胰岛素抵抗指数（HOMA-IR）来评估患者术前的胰岛素抵抗，采集血样检测术前肾上腺素和皮质醇水平，还采用状态-特质焦虑量表和事件影响量表来评估患者的心理应激状态。手术后，该研究监测了1个月内吻合口漏的发生情况。采用多变量逻辑回归进行数据分析。结果表明，术前胰岛素抵抗、两种激素水平升高以及心理应激评分增加与吻合口漏风险增加显著相关。当肾上腺素和皮质醇水平增加一个标准差时，胰岛素抵抗患者术后这种并发症风险的增加幅度大于无胰岛素抵抗的患者。总之，术前胰岛素抵抗和应激反应都是结直肠癌手术后吻合口漏的潜在危险因素。
