title: Significance of diabetes on morbidity and mortality following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Reese W
authors.initials: RW
authors.lastname: Randle
authors.forename: Shuja
authors.initials: S
authors.lastname: Ahmed
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.forename: Katrina R
authors.initials: KR
authors.lastname: Swett
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D016022:Case-Control Studies; D010478:Chemotherapy, Cancer, Regional Perfusion; D002648:Child; D065426:Cytoreduction Surgical Procedures; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006979:Hyperthermia, Induced; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D011014:Pneumonia / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D055815:Young Adult
keywords: HIPEC; carcinomatosis; cytoreduction; diabetes; morbidity and mortality