Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk?

Abstract

Background Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection. Methods Four hundred seventeen major liver resections (≥ 3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m2 and < 30 kg/m2 and obesity as BMI ≥ 30 kg/m2. Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien–Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively. Results Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien–Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

“…Of these, 215 articles were excluded resulting in 154 studies that met the selection criteria. We excluded 25 studies with no usable data: 23 did not report baseline risk for mortality by BMI group, 17‐39 1 only reported a p value, 40 and another 1 mentioned data in a supplement that were not available 41 . Disagreements about the inclusion of studies occurred in 16% of the articles ( kappa = 0·67).…”

Tc‐99m mebrofenin hepatobiliary scintigraphy to assess future liver remnant function before major liver surgery

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Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction

“…However, the impact of diabetes on liver resection has been controversial, especially the influence of bile leakage ( 26 ). Diabetes can cause microcirculation disorders and affect tissue healing and is generally considered an independent risk factor for bile leakage ( 3 , 27 ). Research by Yamamoto et al ( 28 ) pointed out that diabetes can damage the residual liver after hepatectomy and affect healing of the cut surface tissue, which may increase the risk of post-operative bile leakage.…”