To Explore The Effect Of Different Surgical Methods And Plasma Glucose On The Prognosis Of Radical Resection Of Colon Cancer

Objectives1.To explore that whether there are differences in the incidence of postoperative complications in patients undergoing radical resection of colon cancer under different surgical methods.2.To explorethat whether the history of diabetes mellitus,preoperative glycosylated hemoglobin(HbA1c),and hyperglycemia are the independent risk factors for poor prognosis after laparoscopic radical resection of colon cancer and whether exists other possible influencing factors.MethodsThis study is divided into two parts.Part 1: Collect the patients who the time of admission was from June 1st,2015 to December 31 st,2016 at the Department of Colorectal Surgery,Union Hospital Affiliated to Fujian Medical University and was diagnosed as “colon cancer ”.Those patients underwent radical resection.According to the inclusion and exclusion criteria to select the object of study.The diagnostic criteria for all colon cancers were: endoscopic biopsy and pathology confirmed as malignant.A retrospective analysis was performed on all patients included to understand the incidence of postoperative complications.The χ2 test of the four-cell table was used to compare the incidence of postoperative complications between laparoscopic and open radical surgery.Part 2: According to the new inclusion and exclusion criteria.Retrospective analysis was used to analyze the influencing factors of postoperative complications of laparoscopic radical resection of colon cancer.The meaningful factors from univariate analysis were adopted into logistic multivariate analysis to presume whether preoperative HbA1 c,diabetes history,and hyperglycemia status are independent risk factors for poor prognosis after laparoscopic radical resection of colon cancer and whether exists other possible influencing factors.Meanwhile,preoperativeHbA1 cand the incidence of postoperative complications in patients with diabetes were analyzed by the receiver’s working characteristics(ROC curve)to evaluate HbA1 c prediction performance and find the best cutoff value.Results1.Part 1 included patients: 660 cases.118 patients undergoing open surgery;542 patients undergoing laparoscopic surgery.The number of postoperative complications occurred in patients undergoing open surgery is 24 and the incidence rate is 20.3%;The number of postoperative complications occurred after laparoscopic surgery is 72 and the incidence rate was 13.3%.There was a statistically significant difference in the incidence of postoperative complications(χ2=3.88,p<0.05).2.Total number of patients included in the second part: 421.The number of patients with diabetes is 83 cases.The number of patients with non-diabetic is 383.2.1 According to the logistic multivariate logistic regression analysis,we can draw the conclusion that(1)the length of operation,first postoperative fasting plasma glucose above 11.0 mmol/L,and diabetes were independent risk factors for postoperative complications(P<0.05);(2)fasting plasma glucose ≥7.0 mmol/L was an independent risk factor for postoperative infection(P<0.05).;(3)fasting blood glucose≥7.0mmol/L at admission and length of surgery were independent risk factors for postoperative surgical site infection(P<0.05);(4)fasting plasma glucose ≥7.0 mmol/L at admission,right colon surgery was an independent risk factor for postoperative pulmonary infection(P<0.05).2.2 After chi-square test,the incidence of postoperative complications was statistically different between diabetics and non-diabetics(χ2=12.91,p<0.001);the chi-square test showed that there was statistically significant between the preoperative HbA1c≥6.5% and the increasing incidence of postoperative complications(χ2=5.13,P<0.05).By calculating the receiver operating characteristic curve(ROC curve),the area under the HbA1 C curve is 0.65 and the best critical value is 5.85%.Conclusions1.Open radical surgery postoperative complications increased significantly than laparoscopic radical surgery.2.Diabetic patients were significantly more likely to have postoperative complications than non-diabetic patients,and diabetes was an independent risk factor for increased postoperative complications.In addition,regardless of whether the patient was diabetic or not,the length of surgery and first postoperative plasma glucose were ≥ 11.0mmol/L was also an independent risk factor for postoperative complications.3.Fasting plasmaglucose ≥7.0mmol/L at admission was an independent risk factor for the incidence of postoperative total infection,pulmonary infection and increased incidence of surgical site infection.4.HbA1 c is a risk factor for increased postoperative complications,and preoperative HbA1 C greater than 5.85mmol/L is the best cut-off point for postoperative complications increased.5.There was no significant difference in the length of hospital stays,postoperative first farting time,and the time of drainage tube removal between diabetics and non-diabetics.