Does diabetes mellitus influence the perioperative outcome or long term prognosis after resection of hepatocellular carcinoma?
OBJECTIVE
This study aims to evaluate whether diabetes mellitus has a significant influence on the perioperative outcome or long term prognosis after resection of hepatocellular carcinoma (HCC).


METHODS
The clinicopathological data and postoperative morbidity and mortality of 62 diabetic and 463 nondiabetic patients who underwent resection of HCC between 1989 and 2000 were compared. The long term overall and disease-free survival results were also compared, and the prognostic impact of diabetes mellitus was assessed by multivariate analysis.


RESULTS
The diabetic and nondiabetic groups were comparable in terms of the frequency of cirrhosis, liver function, type of resection, and tumor factors such as size and pTNM stage. Overall complication rate (38.7% vs 37.1%, p = 0.820), 30-day mortality (3.2% vs 3.0%, p = 0.583), and hospital mortality (6.4% vs 6.0%, p = 0.782) were similar in diabetic and nondiabetic patients. There was no significant difference in the overall survival (median = 43.5 vs 43.2 months, p = 0.438) or disease-free survival (median = 18.2 vs 15.0 months, p = 0.418). On multivariate analysis, only tumor pTNM stage, operative blood loss, and preoperative indocyanine green retention at 15 min were significant predictors of overall survival. Tumor pTNM stage, size, and operative blood loss were significant predictors of disease-free survival.


CONCLUSIONS
This study indicates that diabetes mellitus does not increase the perioperative morbidity or mortality after resection of HCC, nor does it significantly influence the long term prognosis. Based on the current study data, diabetes mellitus should not be considered an unfavorable factor in the selection of patients for resection of HCC.
Poon
Ronnie Tung-Ping
RT
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Fan
Sheung-Tat
ST
Wong
John
J
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome