Exp Clin Endocrinol Diabetes 2006; 114(5): 257-261
DOI: 10.1055/s-2006-924234
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Diabetes Mellitus is no Independent Risk Factor for Perioperative Mortality Following Hepatic Resection

O. Guckelberger1 , A. Thelen1 , C. Benckert1 , C. Schoebel1 , S. Reuter1 , J. Klupp1 , S. Jonas1 , P. Neuhaus1
  • 1Charité - Campus Virchow-Klinikum, Department of General, Visceral and Transplantation Surgery, Berlin, Germany
Further Information

Publication History

Received: April 11, 2005 First decision: September 23, 2005

Accepted: March 7, 2006

Publication Date:
28 June 2006 (online)

Abstract

For patients with concomitant diabetes mellitus an increased perioperative mortality and morbidity in hepatic resections has repeatedly been described. Other studies, however, demonstrated equal outcome data in diabetic and non-diabetic patients. As patient populations were selected for underlying disease, conflicting results may reflect patient selection criteria rather than impact of diabetes mellitus on outcome measures. Therefore, a multivariate analysis in a largely unselected patient population has been performed to determine the independent prognostic value of diabetes mellitus in liver surgery. From a prospective database 633 adult patients undergoing hepatic resection without preceding major abdominal surgery or chemotherapy have been identified. Besides diabetes mellitus, demographic data, variables expressing the functional reserve of the liver, and parameters of surgical technique were analyzed for their impact on mortality and morbidity. 75 patients were diabetic (11.8 %) and 96 hepatic resections (15.2 %) were performed in cirrhotic patients. In the univariate analysis, concomitant diabetes was associated with an increased mortality compared to all non-diabetic patients (10.7 % vs. 5.3 %, p = 0.047). Diabetic patients, however, were also significantly older and presented a higher prevalence of liver cirrhosis. Multivariate modeling finally identified only age, albumin, cirrhosis, extent of surgery, and era of surgery as independent variables with an impact on perioperative mortality. Overall, complications were detected in diabetic and non-diabetic patients with a comparable frequency (44 % vs. 36 %, p = 0.179). Also, the length of in-hospital stay did not significantly differ between both groups (18.5 ± 1.7 vs. 17.7 ± 1.0 days, p = 0.119). Rates of postoperative renal impairment, prolonged ascites or pneumonia, however, were higher in diabetics than in other patients. Following established cardiopulmonary and surgical selection criteria, diabetes mellitus is not an independent risk-factor for perioperative mortality in hepatic resections. Although the overall postoperative morbidity was not different in diabetic and non-diabetic patients, a specific pattern of complications has been identified, mandating particular attention in the postoperative course of diabetic patients.

References

  • 1 Aldrighetti L, Arru M, Calori G, Caterini R, Comotti L, Torri G, Ferla G. Impact of age on the outcome of liver resections.  Am Surg. 2004;  70 453-460
  • 2 Chiappa A, Zbar A P, Biella F, Crotti C, Staudacher C. Validity of hepatic resection for cancer in the elderly.  Ann Ital Chir. 2002;  73 397-401
  • 3 Chin S, Ramirez S, Greenbaum L E, Naji A, Taub R. Blunting of the immediate-early gene and mitogenic response in hepatectomized type 1 diabetic animals.  Am J Physiol. 1995;  269 E691-E700
  • 4 Couinaud C. Anatomic principles of left and right regulated hepatectomy: Technics.  J Chir (Paris). 1954;  70 933-966
  • 5 Dimick J B, Wainess R M, Cowan J A, Upchurch Jr G R, Knol J A, Colletti L M. National trends in the use and outcomes of hepatic resection.  J Am Coll Surg. 2004;  199 31-38
  • 6 Ezaki T, Yukaya H, Ogawa Y. Evaluation of hepatic resection for hepatocellular carcinoma in the elderly.  Br J Surg. 1987;  74 471-473
  • 7 Haber B A, Chin S, Chuang E, Buikhuisen W, Naji A, Taub R. High levels of glucose-6-phosphatase gene and protein expression reflect an adaptive response in proliferating liver and diabetes.  J Clin Invest. 1995;  95 832-841
  • 8 Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, Adachi W, Amano J. Hepatic resection for hepatocellular carcinoma in the elderly.  J Am Coll Surg. 2001;  192 38-46
  • 9 Huo T I, Lui W Y, Huang Y H, Chau G Y, Wu J C, Lee P C, Chang F Y, Lee S D. Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: A longitudinal study.  Am J Gastroenterol. 2003;  98 2293-2298
  • 10 Huo T I, Wu J C, Lui W Y, Huang Y H, Lee P C, Chiang J H, Chang F Y, Lee S D. Differential mechanism and prognostic impact of diabetes mellitus on patients with hepatocellular carcinoma undergoing surgical and nonsurgical treatment.  Am J Gastroenterol. 2004;  99 1479-1487
  • 11 Ikeda Y, Shimada M, Hasegawa H, Gion T, Kajiyama K, Shirabe K, Yanaga K, Takenaka K, Sugimachi K. Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection.  Hepatology. 1998;  27 1567-1571
  • 12 Johnston D G, Johnson G A, Alberti K G, Millward-Sadler G H, Mitchell J, Wright R. Hepatic regeneration and metabolism after partial hepatectomy in diabetic rats: Effects of insulin therapy.  Eur J Clin Invest. 1986;  16 384-390
  • 13 Kooby D A, Jarnagin W R. Surgical management of hepatic malignancy.  Cancer Invest. 2004;  22 283-303
  • 14 Little S A, Jarnagin W R, DeMatteo R P, Blumgart L H, Fong Y. Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer.  J Gastrointest Surg. 2002;  6 88-94
  • 15 Lui W Y, Chau G Y, Wu C W, King K L. Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients.  Hepatogastroenterology. 1999;  46 640-645
  • 16 Melendez J, Ferri E, Zwillman M, Fischer M, DeMatteo R, Leung D, Jarnagin W, Fong Y, Blumgart L H. Extended hepatic resection: A 6-year retrospective study of risk factors for perioperative mortality.  J Am Coll Surg. 2001;  192 47-53
  • 17 Pocard M, Vincent-Salomon A, Girodet J, Salmon R J. Effects of preoperative chemotherapy on liver function tests after hepatectomy.  Hepatogastroenterology. 2001;  48 1406-1408
  • 18 Poon R T, Fan S T. Hepatectomy for hepatocellular carcinoma: Patient selection and postoperative outcome.  Liver Transpl. 2004;  10 S39-S45
  • 19 Poon R T, Fan S T, Lo C M, Liu C L, Lam C M, Yuen W K, Yeung C, Wong J. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: Analysis of 1222 consecutive patients from a prospective database.  Ann Surg. 2004;  240 698-710
  • 20 Poon R T, Fan S T, Wong J. Does diabetes mellitus influence the perioperative outcome or long term prognosis after resection of hepatocellular carcinoma?.  Am J Gastroenterol. 2002;  97 1480-1488
  • 21 Pringle H. Notes on the arrest of hepatic hemorrhage due to trauma.  Ann Surg. 1908;  48 541-549
  • 22 Pugh R N, Murray-Lyon I M, Dawson J L, Pietroni M C, Williams R. Transection of the oesophagus for bleeding oesophageal varices.  Br J Surg. 1973;  60 646-649
  • 23 Redai I, Emond J, Brentjens T. Anesthetic considerations during liver surgery.  Surg Clin North Am. 2004;  84 401-411
  • 24 Shimada M, Takenaka K, Fujiwara Y, Gion T, Shirabe K, Yanaga K, Sugimachi K. Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.  Br J Surg. 1998;  85 195-198
  • 25 Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, Sugimachi K. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume.  J Am Coll Surg. 1999;  188 304-309
  • 26 Takenaka K, Shimada M, Higashi H, Adachi E, Nishizaki T, Yanaga K, Matsumata T, Ikeda T, Sugimachi K. Liver resection for hepatocellular carcinoma in the elderly.  Arch Surg. 1994;  129 846-850
  • 27 Wu Y L, Yu J X, Xu B. Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients.  World J Gastroenterol. 2004;  10 1995-1997
  • 28 Yanaga K, Kanematsu T, Takenaka K, Matsumata T, Yoshida Y, Sugimachi K. Hepatic resection for hepatocellular carcinoma in elderly patients.  Am J Surg. 1988;  155 238-241

Dr. med. Olaf Guckelberger

Charité - Campus Virchow-Klinikum
Department of General, Visceral and Transplantation Surgery

Augustenburger Platz 1

13353 Berlin

Germany

Phone: + 4930450552001

Fax: + 49 30 450 552 900

Email: olaf.guckelberger@charite.de

    >