Intensive Insulin Therapy after Surgery in Patients with Esophageal Cancer

Shunzo Hatooka, Masayuki Shinoda, Motokazu Suyama and Tetsuya Mitsudomi

Department of Thoracic Surgery, Aichi Cancer Center Hospital

Purpose: We evaluated the clinical efficacy of the normalization of blood glucose levels in postoperative patients with esophageal cancer. Patients and methods: We reviewed the records of 41 patients with esophageal cancer who underwent esophagectomy between January 1, 2002, and February 28, 2003. They were categorized into a control group (24), which received no insulin therapy, and an intensive insulin therapy group (17), which underwent continuous insulin pump infusion when blood glucose exceeded 150 mg/dl. Infusion was adjusted to maintain a level between 90 and 150 mg/dl. We retrospectively analyzed 12 clinical variables using an unpaired t test and Fisher's exact probability test. Results: In the intensive insulin group, the blood glucose level was maintained at a mean 137 mg/dl. Hypoglycemia (defined as a blood glucose level of 50 mg/dl or less) did not occur in any patient in this group. Albumin was significantly higher in the intensive insulin therapy group than in the control group on postoperative days 1, 2, and 3 (P<0.01). No difference was seen in markers for inflammation (C-reactive protein level, and white-cell count) between groups. The duration of systemic inflammatory response syndrome was shorter in the intensive insulin therapy group, although not statistically significant (P=0.057). The number of patients experiencing postoperative infection was nearly significantly smaller in the intensive insulin therapy group (P=0.057). Conclusion: Intensive insulin therapy to maintain blood glucose at or below 150 mg/dl is safe and feasible, and may reduce infectious complications after esophageal surgery.

Key words
blood glucose, hyperglycemia, insulin, postoperative care, esophageal neoplasms

Reprint requests
Shunzo Hatooka Department of Thoracic Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681 JAPAN

Accepted
April 28, 2004

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