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Impact of pre-diabetes, well-controlled diabetes, and poorly controlled diabetes on anastomotic leakage after esophagectomy for esophageal cancer: a two-center retrospective cohort study of 1901 patients

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Abstract

Background

Diabetes is known to be associated with anastomotic leakage (AL) after esophagectomy. However, it is unknown whether well-controlled diabetes is also associated with AL.

Methods

We conducted a two-center retrospective cohort database study of patients who underwent oncological esophagectomy (2011–2019). Patients were divided into four groups: normoglycemia, pre-diabetes, well-controlled diabetes (hemoglobin A1c [HbA1c] < 7.0%), and poorly controlled diabetes (HbA1c ≥ 7.0%). The occurrence of AL and length of stay were compared between groups using multivariable analyses. The relationship between categorical HbA1c levels and AL was also investigated in patients stratified by diabetes medication before admission.

Results

Among 1901 patients, 1114 (58.6%) had normoglycemia, 480 (25.2%) had pre-diabetes, 180 (9.5%) had well-controlled diabetes, and 127 (6.7%) had poorly controlled diabetes. AL occurred in 279 (14.7%) patients. Compared with normoglycemia, AL was significantly associated with both well-controlled diabetes (odds ratio 1.83, 95% confidence interval [CI] 1.22–2.74) and poorly controlled diabetes (odds ratio 1.95, 95% CI 1.23–3.09), but not with pre-diabetes. Preoperative HbA1c levels showed a J-shaped association with AL in patients without diabetes medication, but no association in patients with diabetes medication. Compared with normoglycemia, only poorly controlled diabetes was significantly associated with longer hospital stay after surgery, especially in patients with operative morbidity (unstandardized coefficient 14.9 days, 95% CI 5.6–24.1).

Conclusions

Diabetes was associated with AL after esophagectomy even in well-controlled patients, but pre-diabetes was not associated with AL. Operative morbidity, including AL, in poorly controlled diabetes resulted in prolonged hospital stays compared with normoglycemia.

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Author information

Author notes

  1. Hisashi Fujiwara

    Present address: Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

Authors and Affiliations

  1. Division of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yuki Hirano, Daisuke Kurita, Koshiro Ishiyama, Junya Oguma & Hiroyuki Daiko

  2. Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan

    Yuki Hirano, Takeo Fujita, Kazuma Sato & Hisashi Fujiwara

  3. Department of Hepatobiliary–Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan

    Yuki Hirano & Osamu Itano

  4. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Takaaki Konishi

  5. Biostatistics Unit, Clinical and Translational Research Centre, Keio University Hospital, Tokyo, Japan

    Ryo Takemura

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  1. Yuki Hirano
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Contributions

YH: conceptualization, data curation, formal analysis, investigation, methodology, project administration, visualization, writing—original draft. TF: conceptualization, project administration, resources, supervision, writing—review & editing. TK: methodology, validation, writing—review & editing. RT: methodology, validation, writing—review & editing. KS: data curation, investigation, writing—review & editing. DK: data curation, investigation, writing—review & editing. KI: data curation, investigation, writing—review & editing. HF: data curation, investigation, writing—review & editing. JO: conceptualization, investigation, writing—review & editing. OI: conceptualization, supervision, writing—review & editing. HD: conceptualization, project administration, resources, supervision, writing—review & editing.

Corresponding author

Correspondence to Hiroyuki Daiko.

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Ethical Statement

This two-center retrospective study was approved by the Ethics Committee at NCCH (2020-303).

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The authors have no conflicts of interest to declare.

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Hirano, Y., Fujita, T., Konishi, T. et al. Impact of pre-diabetes, well-controlled diabetes, and poorly controlled diabetes on anastomotic leakage after esophagectomy for esophageal cancer: a two-center retrospective cohort study of 1901 patients. Esophagus 20, 246–255 (2023). https://doi.org/10.1007/s10388-022-00965-y

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