Head and neck cancer patients: impact of diabetes mellitus on surgical outcomes.

PURPOSE: Cancer patients with significant comorbidities undergoing major surgical intervention are at high risk for peri/postoperative complications and a prolonged hospital stay. Diabetes mellitus is a prevalent chronic metabolic disease, reported to affect surgery outcomes of malignancies. The purpose of this article was to evaluate the impact of diabetes mellitus on the development of local and systemic complications as well as the length of the hospital stay, after major surgery for Head and Neck (H&N) cancer.

METHODS: A total of 168 patients suffering from H&N cancer, surgically treated between 2004 and 2013 at our ENT Department, were included. Clinical records were examined, particularly focusing on the onset of local and systemic complications and on the length of the hospital stay. The subjects considered as diabetics were the ones with a history of physician-diagnosed diabetes or those who were taking oral hypoglycemic drugs or insulin. For those without a diagnosis of diabetes and not taking any antidiabetic medications, the value of fasting blood glucose was used to assess the presence of diabetes, according to the American Diabetes Association guidelines (glycaemia >126 mg/dl). The occurrence of local and systemic postoperative complications, as well as the length of the hospital stay, were statistically compared between the diabetic and non-diabetic group of patients.

RESULTS: 31 of 168 (18.5%) patients, surgically treated for H&N cancer, had also been diagnosed with diabetes mellitus. Episodes of postoperative complications in non-diabetic patients were 50.4%, whereas in diabetics 45.2%. The mean length of hospital stay for non-diabetics was 28.1±14.8 days and for diabetics 32.2±24. In univariate and multivariate analysis, no statistically significant differences were found when comparing the diabetic to the non-diabetic group, in terms of occurrence of postoperative complications in respect to cancer stage and length of hospitalization. In univariate and multivariate analyses none of the variables studied was a risk factor for postoperative complications.

CONCLUSIONS: This study provides evidence that a good metabolic control of diabetes mellitus does not have impact on the occurrence of peri/postoperative complications and therefore on the length of hospital stay of H&N cancer patients.