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. 2023 Aug;53(8):907-916.
doi: 10.1007/s00595-023-02641-9. Epub 2023 Jan 20.

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

Chihiro Koga  1 , Kotaro Yamashita  2 , Yoshiro Yukawa  1 , Koji Tanaka  1 , Tomoki Makino  1 , Takuro Saito  1 , Kazuyoshi Yamamoto  1 , Tsuyoshi Takahashi  1 , Yukinori Kurokawa  1 , Kiyokazu Nakajima  1 , Hidetoshi Eguchi  1 , Yuichiro Doki  1
Affiliations

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

Chihiro Koga et al. Surg Today. 2023 Aug.

Abstract

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.

Keywords: Esophageal cancer; Esophagectomy; Overall survival; Postoperative blood glucose; Postoperative complications.

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