The Effect of Diabetes on the Perioperative Outcomes of Colorectal Cancer Surgery Patients

Abstract

There are approximately 1.3 million patients in Australia with diabetes. Conflicting reports exist in the literature as to the effect of diabetes on the outcomes of colorectal cancer patients. We hypothesized that patients with diabetes would have poorer perioperative outcomes, and that diabetes was an independent risk factor for both 30-day mortality and perioperative morbidity. The aim of this study was to assess the impact of diabetes on perioperative colorectal cancer surgery outcomes, as compared to a diabetes-free reference population, and to examine factors affecting perioperative risk. We conducted an analysis of a prospectively collected, clinician-led colorectal cancer database of patients from 2010–2015. Patients with diabetes were compared to patients without diabetes on a range of perioperative outcomes. Pearson χ-squared tests, Wilcoxon rank sum tests and t-tests were employed for univariate analyses. Confounding factors were controlled for by separate logistic and linear regression analyses. The Huber-White Sandwich Estimator was used to calculate robust standard errors. A total of 1725 patients were analysed over 1745 treatment episodes in the study period with 267 patients (268 episodes) with diabetes studied. Diabetes contributed to medical, surgical complications, and increased length of inpatient stay in univariate analyses. Multivariable analysis adjusted for variables independently associated with each outcome revealed that diabetes was an independent contributor to an increased risk of surgical complications, with no significant effect on medical complications, return to the operating room, 30-day mortality, or readmission within 30 days. In this study, where overall baseline morbidity and mortality levels are low, the effect of diabetes alone on perioperative surgical outcomes appears to be overstated with control of associated perioperative risk factors such as cardiac, renal and respiratory factors being more important.

The Impact of Comorbid Diabetes on Short‐Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

“…The present study identified that 21.94% of stage I/II colon cancer patients undergoing open colectomy had comorbid diabetes in the US. The diabetes prevalence rate in our study population seems to be higher than those previously reported in New Zealand, England, and Australia (10.9% to 16.8%) [10][11][12]; however, these previous studies did not specifically focus on stage I/II colon cancer and open colectomy, so no fair comparison can be made. Furthermore, Sarfati et al [10] reported that among colon cancer patients with comorbid diabetes, 54.13% of them had uncomplicated diabetes and 45.87% had complicated diabetes, although no information about cancer stage was available in their study.…”

“…Comorbidity is associated with adverse outcomes in colon cancer patients after surgery, and diabetes is one of the most common comorbidities [8,9]. Among colon cancer patients, the diabetes prevalence rates were 10.9%, 11.4%, and 16.8% in New Zealand, England, and Australia, respectively [10][11][12]. However, most studies that investigated the effect of comorbid diabetes on short-term surgical outcomes in colorectal cancer did not distinguish colon cancer from rectal cancer [13][14][15][16].…”

Optimal Starting Age for Colorectal Cancer Screening in an Era of Increased Metabolic Unhealthiness: A Nationwide Korean Cross-Sectional Study

“… 18 , 19 It has been reported that metabolic syndrome or DM is associated with not only an increased risk for CRC 20 – 23 but all-cause and CRC-specific mortality. 24 – 27 The present study also showed the increased mortality in CRC patients with DM. However, dyslipidemia was associated with a lower mortality rate might be due to the anti-CRC properties of statin.…”

Perirenal fat surface area as a risk factor for perioperative difficulties and 30‐day postoperative complications in elective colon cancer surgery

“…As we limited selection to a set of standard colon operations, our results can only be generalized to this group. We adjusted for known confounding factors, such as age and anaesthesiological risk according to ASA class, but we did not adjust for specific comorbidities such as diabetes , smoking , physical activity or alcohol misuse . Our cohort ranged over a large year span, from 2006 to 2016.…”