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DOES DIABETES MELLITUS INFLUENCE THE LONG-TERM OUTCOME AFTER RECTAL CANCER RESECTIONS(?) AND RESULTS OBTAINED IN A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY
Bjoern Gebauer*1,2, Ingo Gastinger2, Henry Ptok1,2, Ralf Steinert3,2, Ronny Otto2, Stefanie Wolff1,2, Hans Lippert2, Frank Meyer1,2
1Dept. of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany; 2Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany; 3Dept. of General and Abdominal Surgery, St Josefs Hospital, Magdeburg, Germany
Objective: Data concerning the impact of diabetes mellitus on the long-term outcome after elective resection for rectal cancer is limited. The aim of this study is to identify and evaluate a potential impact using data from a German major observational study.
Methods: Patient-record was gathered by a prospective multicenter observational study “Rectal cancer (primary tumor) - elective surgery”. 68 items concerning the preoperative status, surgical procedure and histological findings till discharge from hospital to characterize early postoperative results (further study aspect) were documented and a consecutive follow-up was added to analyze oncological outcome as shown. Informed consent of the patient was necessary. Patients were grouped in ones without diabetes, insulin-dependent diabetes patients (IDDM) and non-insulin-dependent diabetes (NIDDM), respectively. Endpoints were overall survival (OS), disease-free survival (DFS) and local recurrence rate (LRR) after five years.
Results: 10,442 patient-records were eligible, including 8,546 (81.8%) patients without diabetes, 1,145 (11.0%) with NIDDM and 751 (7.2%) with IDDM. The mean age at admission was 68 (range, 21-99) years whereat NIDDM (70.9y) and IDDM (71.7yr) patients were older than patients without diabetes (67.3yr) (P<0.001). ASA classifications were higher in NIDDM and IDDM groups (P<0.001) but UICC tumor stages were similar between the groups (P=0.547). The best 5-year OS was observed in non-diabetic patients (60.6%) whereas NIDDM (53.3%) and IDDM (46.4%) patients had worse a worse outcome (P<0.001). The difference between NIDDM and IDDM was also significant (P=0.008). DFS after five years was observed at 58.5% for patients without diabetes. NDDIM and IDDM patients had a worse DFS (P<0.01) without differences between the diabetes groups (P=0.106). In total, 112 local recurrences occurred after five years. 4.6% of the patients without diabetes developed a local recurrence after 5 years. A trend was observed that NIDDM-patients had a higher LRR, which was 7.8 % (P=0.058). A significant difference between no diabetes and IDDM patients was not observed due to only 8 IDDM-patients (8.3%) developing local recurrence (P=0.524).
Conclusion: In summary, patients with diabetes had a worse long-term outcome. OS and DFS were significantly worse than in patients without diabetes. This might have been at least partly due to higher age. Furthermore, it can be concluded, that IDDM is related to an even worse outcome than NIDDM, noticing the almost equivalent age at admission. Diabetes was also likely to raise the risk of local recurrence by trend.
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