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Significance of diabetes on morbidity and mortality following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
Author(s) -
Randle Reese W.,
Ahmed Shuja,
Levine Edward A.,
Fino Nora F.,
Swett Katrina R.,
Stewart John H.,
Shen Perry,
Votanopoulos Konstantinos I.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23865
Subject(s) - medicine , diabetes mellitus , hyperthermic intraperitoneal chemotherapy , complication , cytoreductive surgery , surgery , chemotherapy , retrospective cohort study , cancer , ovarian cancer , endocrinology
Background and Objectives Patients with diabetes suffering from peritoneal surface disease represent a challenge to treat due to the effects of both processes on multiple organ systems. We sought to define the impact of diabetes on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Methods A retrospective analysis of a prospective database of 1065 CRS/HIPEC procedures was conducted. Patient demographics, comorbidities, and tumor characteristics were reviewed. Results CRS/HIPEC was performed in 91 diabetic and 844 non‐diabetic patients with peritoneal surface disease from 1991 to 2013. Diabetics and non‐diabetics spent 6.8 and 3.1 ( P = 0.009) days in the ICU, respectively. Diabetics were more likely to suffer major complications ( P < 0.001) including infectious ( P < 0.001) and thrombotic ( P = 0.05) complications, arrhythmias ( P = 0.007), renal insufficiency ( P = 0.002) and respiratory failure ( P = 0.002) than non‐diabetics. Mortality was significantly worse for diabetic patients at 30‐days (8.8% vs. 2.7%, P = 0.007) and at 90‐days (13.2% vs. 5.2%, P = 0.008). Even after adjusting for other significant predictors of morbidity, diabetes predicted more major complications and increased mortality following CRS/HIPEC. Conclusions Diabetes predicts major complications and specific complication patterns associated with increased ICU stay and worse mortality in patients undergoing CRS/HIPEC. Diabetic patients deemed to be appropriate candidates for CRS/HIPEC should be treated with caution. J. Surg. Oncol. 2015 111:740–745 . © 2014 Wiley Periodicals, Inc.