Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer
Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer
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DOI：
10.1016/s1091-255x(01)00019-1
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发表时间：
2002-01-01
影响因子：
3.2
通讯作者：
Fong, YM
中科院分区：
文献类型：
--
作者：
Little, SA;Jarnagin, WR;Fong, YM
糖尿病与肝脏代谢和免疫反应的改变有关，这可能影响癌症肝切除术后的术后恢复和长期生存。从前瞻性数据库中确定有可能治愈的转移性结直肠癌的I型或11型糖尿病患者，并将其与同一时间间隔内没有糖尿病的肝结直肠癌转移患者进行比较。分析手术发病率、死亡率和长期生存率。1990年12月至1999年7月，共有772例患者接受了肝切除术，其中61例（8.1%）患有I型和11型糖尿病。糖尿病患者的手术死亡率明显高于非糖尿病患者（8% vs. 2%, P < 0.02）。在糖尿病患者中，5例围手术期死亡中有4例是由于大肝切除术（肺叶切除术或更大）后肝功能衰竭。这4例患者均有明显的实质异常（其中3例伴有脂肪变性）。长期生存率与非糖尿病对照组相同。我们得出结论，糖尿病的存在与围手术期死亡率的较高发生率相关。对于合并糖尿病和实质脂肪变性的患者，应谨慎进行肝切除术。
Diabetes is associated with alterations in liver metabolism and immune response that may influence postoperative recovery and long-term survival after hepatectomy for cancer. Patients with type I or type 11 diabetes mellitus submitted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospective database, and compared with patients with hepatic colorectal metastases submitted to resection during the same time interval, but without diabetes mellitus. Data on operative morbidity and mortality and long-term survival were analyzed. Between December 1990 and July 1999, a total of 72 7 patients underwent hepatic resection, 61 of whom (8.1%) had type I and type 11 diabetes mellitus. Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients (8% vs. 2%, P < 0.02). Among patients with diabetes mellitus, four of the five perioperative deaths were due to liver failure after major hepatic resection (lobectomy or greater). All four of these patients had significant parenchymal abnormality (three with steatosis). Long-term survival was identical to that in nondiabetic control subjects. We conclude that the presence of diabetes is associated with a higher incidence of perioperative mortality. In patients with diabetes mellitus and parenchymal steatosis, major hepatic resection should be undertaken with caution.