The Impact of Type 2 Diabetes Mellitus on Treatment Outcomes in Patients Operated for Stage III Rectal Adenocarcinoma
DOI:
https://doi.org/10.55791/1yy0zq79Keywords:
colorectal surgery, metabolic diseases, patient outcome assessment, neoplasmsAbstract
Introduction: Colorectal cancer (CRC) ranks as the world's fourth most prevalent cancer and is the third leading cause of death globally. Stage III CRC indicates localized spread to nearby lymph nodes without metastasis to other body parts. While numerous studies have explored outcomes in CRC patients based on various predictive factors, a comprehensive literature review has identified a gap in research specifically investigating surgical outcomes for stage III rectal adenocarcinoma in individuals with type 2 diabetes mellitus (DM2).
Aim: To explore the impact of DM2 on treatment outcomes in patients undergoing surgery for stage III rectal adenocarcinoma.
Patients and methods: Our retrospective cohort study involved 95 patients who underwent elective radical anterior rectal resection with established mechanical colorectal anastomosis. Patients were categorized into two groups based on DM2 status.
Results: Univariate regression analysis demonstrated that DM2 patients face a significantly higher risk of preoperatively elevated carcinoembryonic antigen levels and postoperative complications such as surgical site infection, urinary issues, and anastomotic leakage. Kaplan-Meier analysis indicated a shorter time to complication onset, particularly anastomotic leakage, and a diminished overall survival in DM2 patients.
Conclusion: DM2 emerged as a significant prognostic factor influencing the treatment outcomes of patients undergoing surgery for stage III rectal adenocarcinoma.
References
Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol 2019; 14(2):89–103.
Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol 2021; 14(10):101174.
Cancer.org. Colon Cancer Treatment, by Stage. Available from: URL:https://www.cancer.org/cancer/types/colon-rectal-cancer/treating/by-stage- colon.html (date last accessed: Jan 9, 2024).
Delibegovic S. Introduction to Total Mesorectal Excision. Med Arch. 2017; 71(6):434-438.
McVey JC, Sasaki K, Beyer K, Nowacki AS, Firl DJ, He J, et al. The impact of resection margin on overall survival for patients with colon cancer liver metastasis varied according to the primary cancer location. HPB 2019; 21(6):702–10.
Roy A, Sahoo J, Kamalanathan S, Naik D, Mohan P, Kalayarasan R. Diabetes and pancreatic cancer: Exploring the two-way traffic. World J Gastroenterol 2021; 27(30):4939–62.
Abudawood M. Diabetes and cancer: A comprehensive review. J Res Med Sci 2019; 24:94.
Petrelli F, Ghidini M, Rausa E, Ghidini A, Cabiddu M, Borgonovo K, et al. Survival of colorectal cancer patients with ciabetes mellitus: A meta-analysis. Can J Diabetes 2021; 45(2):186-197.e2.
Amshoff Y, Maskarinec G, Shvetsov YB, Raquinio PH, Grandinetti A, Setiawan VW, et al. Type 2 diabetes and colorectal cancer survival: The multiethnic cohort. Int J Cancer 2018; 143(2):263–8.
Brown JC, Zhang S, Ou F, Venook AP, Niedzwiecki D, Heinz Josef Lenz, et al. Diabetes and clinical outcome in patients with metastatic colorectal cancer: CALGB 80405 (Alliance). JNCI Cancer Spectrum 2019; 4(1): pkz078
Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. StatPearls (serial online) 2023 Jan "cited 2024 Jan 9"; Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK441940/.
Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A critical review of clinimetric properties. Psychother and Psychosom 2022; 91(1):8–35.
Golder H, Casanova D, Papalois V. Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications. Cir Esp (Engl Ed) 2023; 101(9):637-642
Zhang D. Correlation between blood glucose control and levels of carbohydrate antigen 19-9 and carcinoembryonic antigen in patients with type-2 diabetes mellitus. Diabetes Metab Syndr Obes 2022; 15:2489-2495.
Màrmol JM, Carlsson M, Raun SH, Grand MK, Sørensen J, Lang L, et al. Insulin resistance in patients with cancer: a systematic review and meta-analysis. Acta Oncol 2023; 62(4):364-371.
Salari N, Karami MM, Bokaee S, Chaleshgar M, Shohaimi S, Akbari H, et al. The prevalence of urinary tract infections in type 2 diabetic patients: a systematic review and meta-analysis. Eur J Med 2022; 27(1):20.
D'souza-Ferrer C, Birch R, Howell S, Ajjan R, Downing A. The relationship between diabetes mellitus and the development of postoperative renal complications following major resection of a colorectal cancer. Eur J Surg Oncol 2022; 48(2):e94.
Silvestri M, Dobrinja C, Scomersi S, Giudici F, Turoldo A, Princic E, et al. Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg today 2018; 48:338-345.
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TATME registry. Ann Surg 2019; 269(4):700–711.
Soyoye DO, Abiodun OO, Ikem RT, Kolawole BA, Akintomide AO. Diabetes and peripheral artery disease: A review. World J Diabetes 2021; 12(6):827-838.
Stergios K, Maximos F, Vasilios P, Laskarina MK, Konstantinos K, Stefanidis K, et al. The effect of TISSEEL® on colorectal anastomosis healing process in a diabetic animal experimental model. In Vivo 2020; 34(2):659–65.
Nirenjen S, Narayanan J, Tamilanban T, Subramaniyan V, Chitra V, Fuloria NK, et al. Exploring the contribution of pro-inflammatory cytokines to impaired wound healing in diabetes. Front Immunol 2023; 14:1216321.
Bondarenko LB. Diabetes and collagen: interrelations. Avicenna J Med Biochem 2019; 7(2):64-71.
Morgan RB, Shogan BD. The science of anastomotic healing. Semin Colon Rectal Surg 2022; 33(2):100879.
Hess-Fischl A. Diabetes and Spine Surgery: What You Need to Know: Expert's tips for managing blood sugar when undergoing a back or neck procedure. HealthCentral (serial online). 2019 Dec “cited 2024 Jan 8”; Available from: URL: https://www.healthcentral.com/condition/back-pain/diabetes-spine-surgery-what- you-need-know.
Popescu RC, Leopa N, Dumitru E, Mitroi AF, Tocia C, Dumitru A, et al. Influence of type II diabetes mellitus on postoperative complications following colorectal cancer surgery. Exp Ther Med 2022; 24(4):611.
Smith NT, Xiong S, Bergquist WJ, Blader LR, Tang KK, Cima RR. Improved postoperative blood glucose control through implementation of clinical pharmacist-driven glycemic management model after colorectal surgery. Am J Surg 2023; 225(6):1050-1055.
Yuan C, Zhang X, Babic A, Morales-Oyarvide V, Zhang Y, Smith-Warner SA, et al. Preexisting type 2 diabetes and survival among patients with colorectal cancer. Cancer Epidemiol Biomarkers Prev 2021; 30(4):757-764.
Herold M, Szasz AM, Szentmartoni G, Martinek E, Madar-Dank V, Barna AJ, et al. Influence of the duration of type 2 diabetes mellitus on colorectal cancer outcomes. Sci Rep 2023; 13(1):12985.
Cheng Y, Cheng YX, Liu XY, Kang B, Tao W, Peng D. The effect of type 2 diabetes mellitus on the short-term outcomes and prognosis of stage I-III colorectal cancer: A propensity score matching analysis. Cancer Manag Res 2022; 14:205-214.
Saito A, Kitayama J, Horie H, Koinuma K, Ohzawa H, Yamaguchi H, et al. Metformin changes the immune microenvironment of colorectal cancer in patients with type 2 diabetes mellitus. Cancer Sci 2020; 111(11):4012-4020.
Downloads
Published
Issue
Section
Categories
License
Copyright (c) 2024 South-East European Endo-Surgery Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
