The Effect of Diabetes Mellitus on Outcomes after Major Liver Resection. Is It Really Bad?
Currently over 30 million Americans have diabetes mellitus, over 9% of the US population, and this number continues to rise. It is not uncommon for liver surgeons to encounter diabetic patients who require liver surgery for liver cancers. There is currently no clear answer as to what and if any, increased risk this patients are facing in term of postoperative complications after major liver surgery. Intuitively, it would make sense that diabetes mellitus, a systemic disease affecting many organs in the body including immune system would leads to worse postoperative outcomes. Diabetes mellitus affects tissue healing on a cellular level following liver surgery. Diabetes also causes wound healing problems such as wound infection, skin necrosis, and ultimately a higher hernia formation. Is diabetes a contraindication for liver surgery? Is diabetes affecting liver function/liver growth after surgery? All of these questions are valid and need to be answered. Liver specialist or liver cancer doctor are aware of the dilemmas since many years.
Dr. Iswanto Sucandy and his team at Tampa Liver Cancer program designed a study to investigate the effect of diabetes mellitus on postoperative outcomes for patients undergoing robotic major liver surgery. This study consisted of 94 patients undergoing major hepatectomy for benign and malignant liver tumors. All the operations were performed using robotic liver surgery technique. The type of tumors resected included gallbladder cancer, bile duct cancer, metastatic colon cancer/rectal cancer to the liver, metastatic neuroendocrine tumor to the liver, large hemangioma, large hepatic adenoma, and other symptomatic liver tumors. A tight glucose control before and after the operation were employed following our standardized liver surgery protocol. The results were presented and well received at the 2020 Academic Surgical Congress held in Hilton Lake Buena Vista in Orlando, Florida. The surgical congress was supported by Society of University surgeon and Association for Academic Surgery.
This study showed that diabetes mellitus has no significant effect on outcomes after a robotic major liver surgery. Postoperative wound infection is very minimal, liver regeneration follows the expected curve, and the incidence of postoperative liver failure is minimal. This is an excellent news for many people needing liver surgery. We therefore believe that minimally invasive approach mitigates the negative influence of diabetes in patients undergoing gallbladder cancer, bile duct cancer, or liver tumor surgery. This is the major benefit of avoiding a large open incision to the abdomen, inherent to the traditional open liver surgery. Minimally invasive liver surgery is the future in caring patients with liver cancer. The patient should seek a liver surgeon with expertise in minimally invasive surgery, whenever available.