The impact of postoperative blood glucose levels on complications and prognosis after esophagectomy in patients with esophageal cancer.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: PBGV was associated with postoperative pneumonia, and low IPBG was an independent poor prognostic factor for patients with esophageal cancer.

Changes in blood glucose of elderly patients with gastric cancer combined with type 2 diabetes mellitus after radical operation and the effect of mediation adjustment for blood glucose on the recovery of gastric cancer.

This study aimed to investigate the changes in blood glucose of elderly patients with gastric cancer combined with type 2 diabetes mellitus (T2DM) after radical operation. Forty-six patients in DM group and 30 patients in non-DM group underwent radical surgery between January, 2007 and January, 2017 in The First Hospital of Lanzhou University, and the clinical data were retrospectively analyzed. Statistical analysis was conducted to explore the effect of radical operation on blood glucose control of the two groups of patients. In 46 patients with gastric cancer combined with T2DM, 24 patients received postoperative insulin intervention, and the remaining 22 patients did not receive insulin intervention. This latter set of patients comprised the non-insulin treatment group. Blood glucose control conditions, inflammatory markers, tumor markers and their effects on the prognosis were compared between the two groups. Level of postoperative blood glucose of the DM group was significantly higher than that of the non-DM group (P<0.05), while the level of blood glucose in the insulin treatment group was significantly lower than that in the control group (P<0.05). Levels of related tumor markers and inflammatory factors of insulin treatment group were significantly higher than those of the control group (P<0.05). The 5-year survival rate of insulin treatment group was significantly higher than that of the control group (P<0.05). Our results showed that the level of blood glucose was significantly increased in elderly patients with gastric cancer combined with T2DM after radical operation, and levels of blood glucose, tumor markers and inflammatory factors in elderly gastric cancer patients with T2DM without insulin were significantly increased after radical operation, and long-term prognosis is poor.

Impact of diabetes mellitus and postoperative blood glucose level on the prognosis of pancreatic carcinoma / 中华肝胆外科杂志

Objective To study the impact of diabetes mellitus (DM) and postoperative blood glucose control on the clinicopathological characteristics and prognosis of patients with pancreatic cancer who underwent radical surgery.Methods From January 2010 to January 2015, the clinical and follow-up data of 83 patients with pancreatic cancer who underwent radical surgery at Tianjin Medical University General Hospital were retrospectively studied.Patients were classified into the diabetic group (28 cases) and the non-diabetic group (55 cases) according to the preoperative status of DM.The clinicopathological characteristics, postoperative conditions and prognosis were compared.Results The incidences in the two groups of patients whose postoperative blood glucose levels were poorly controlled were 71.4％ (20/28) and 20.0％ (11/55) in the diabetes group and the non-diabetic groups, respectively.The difference was significant (P ＜0.05).The 3-year survival rate of the diabetic and the non-diabetic groups were 11.3％ and 31.8％ , respectively.The difference was significant (P ＜ 0.05).The 3-year survival rate of patients with poorly-controlled blood glucose levels were 8.8％, and 34.6％, respectively.The difference was significant (P ＜ 0.05).Conclusions The postoperative blood glucose level in pancreatic cancer patients with DM was poorly controlled after radical surgery.The prognosis of pancreatic cancer patients with DM or poorly postoperative blood glucose control was poor after radical surgery.