Association of postoperative outcome with fasting plasma glucose and risk factors in esophageal squamous cell carcinoma / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To study the impact of preoperative fasting plasma glucose(FPG) on postoperative morbidity and outcome following surgical resection of esophageal squamous cell carcinoma (ESCC), and to analyze the risk factor of postoperative complication in ESCC.</p><p><b>METHODS</b>Clinicopathological data of 314 ESCC patients undergoing esophagectomy in our center between January 2011 and December 2012 were retrospectively collected. Patients were divided into two groups according to their preoperative FBG normal FPG group (FPG<6.1 mmol/L, 252 cases) and high FBG group (FPG≥6.1 mmol/L, 62 cases, including 14 diabetes cases). Clinicopathological data and postoperative morbidity were analyzed and compared between two groups. Multivariate logistic regression analysis was used to evaluate risk factors for postoperative complications.</p><p><b>RESULTS</b>There were 278 male and 36 female patients with a median age of 59 years (range 42-83 years). As compared to normal FPG group, high FBG group had higher ratio of female [22.6%(14/62) vs. 8.7%(22/252), P=0.000], older median age (66 years vs. 59 years, P=0.010), lower ratio of smoking and alcohol drinking [48.4%(30/62) vs. 73.8%(186/252), 38.7%(24/62) vs. 69.0%(174/252), both P=0.000], higher ratio of comorbid diabetes and hypertension [51.6%(32/62) vs. 15.1%(38/252), 16.1%(10/62) vs. 1.6%(4/252), both P=0.000]. Pathology results showed 206 patients in normal FPG group (81.7%, 206/252) were moderate-poor differentiation, which was obviously lower than 93.5%(58/62) in high FPG group(P=0.023). Patients of two groups completed their operations successfully. Perioperative overall complication morbidity was 24.2%(76/314), and the most common was lung lesions (24 cases of pneumonia, 10 cases of respiratory failure), then was anastomotic leakage (28 cases) and incision infection (18 cases). Differences in overall and other complication morbidity were not significant between two groups (all P>0.05). Multivariate logistic regression analysis revealed that operation time was an independent risk factor of postoperative complications (P=0.047), anastomosis site was an independent risk factor of anastomotic leakage (P=0.036), and FPG was not a risk factor of postoperative complications(respectively, P=0.683, P=0.836, P=0.784, P=0.637).</p><p><b>CONCLUSIONS</b>Preoperative control of FBG does not increase the postoperative complication morbidity. Shortening operation time and choosing appropriate surgical procedure are important to decrease postoperative complications.</p>