The impact of type 2 diabetes on long-term gastrointestinal sequelae after colorectal cancer surgery: national population-based study

TY - JOUR

T1 - The impact of type 2 diabetes on long-term gastrointestinal sequelae after colorectal cancer surgery

T2 - national population-based study

AU - Laurberg, Tinne

AU - Frandsen, Sara

AU - Larsen, Helene M.

AU - Lehrskov, Louise L.

AU - Graversen, Susanne B.

AU - Drewes, Asbjørn M.

AU - Emmertsen, Katrine J.

AU - Krogh, Klaus

N1 - Publisher Copyright: © 2022 The Author(s).

PY - 2022/8

Y1 - 2022/8

N2 - Background: Long-term gastrointestinal sequelae are common after colorectal cancer surgery, but the impact of type 2 diabetes (T2D) is unknown. Methods: In a cross-sectional design, questionnaires regarding bowel function and quality of life (QoL) were sent to all Danish colorectal cancer survivors, who had undergone surgery between 2001 and 2014 and had more than 2 years follow-up without relapse. The prevalence of long-term gastrointestinal sequelae among colorectal cancer survivors with and without T2D were compared while stratifying for type of surgical resection and adjusting for age, sex, and time since surgery. Results: A total of 8747 out of 14 488 colorectal cancer survivors answered the questionnaire (response rate 60 per cent), consisting of 3116 right-sided colonic, 2861 sigmoid, and 2770 rectal resections. Of these, 690 (7.9 per cent) had a diagnosis of T2D before surgery. Survivors with T2D following rectal resection had a 15 per cent (95 per cent c.i. 7.8 to 22) higher absolute risk of major low anterior resection syndrome, whereas survivors with T2D following right-sided and sigmoid resection had an 8 per cent higher risk of constipation (P < 0.001) but otherwise nearly the same long-term risk of bowel symptoms as those without T2D. For all types of colorectal cancer resections, T2D was associated with a 6-10 per cent higher risk of severe pain (P < 0.035) and a 4-8 per cent higher risk of impaired QoL. Conclusion: T2D at time of surgery was associated with a higher risk of long-term bowel dysfunction after rectal resection, but not after colon resection excluding a higher risk of constipation. T2D was associated with a slightly higher frequency of severe pain and inferior QoL after both rectal and colonic cancer resection.

AB - Background: Long-term gastrointestinal sequelae are common after colorectal cancer surgery, but the impact of type 2 diabetes (T2D) is unknown. Methods: In a cross-sectional design, questionnaires regarding bowel function and quality of life (QoL) were sent to all Danish colorectal cancer survivors, who had undergone surgery between 2001 and 2014 and had more than 2 years follow-up without relapse. The prevalence of long-term gastrointestinal sequelae among colorectal cancer survivors with and without T2D were compared while stratifying for type of surgical resection and adjusting for age, sex, and time since surgery. Results: A total of 8747 out of 14 488 colorectal cancer survivors answered the questionnaire (response rate 60 per cent), consisting of 3116 right-sided colonic, 2861 sigmoid, and 2770 rectal resections. Of these, 690 (7.9 per cent) had a diagnosis of T2D before surgery. Survivors with T2D following rectal resection had a 15 per cent (95 per cent c.i. 7.8 to 22) higher absolute risk of major low anterior resection syndrome, whereas survivors with T2D following right-sided and sigmoid resection had an 8 per cent higher risk of constipation (P < 0.001) but otherwise nearly the same long-term risk of bowel symptoms as those without T2D. For all types of colorectal cancer resections, T2D was associated with a 6-10 per cent higher risk of severe pain (P < 0.035) and a 4-8 per cent higher risk of impaired QoL. Conclusion: T2D at time of surgery was associated with a higher risk of long-term bowel dysfunction after rectal resection, but not after colon resection excluding a higher risk of constipation. T2D was associated with a slightly higher frequency of severe pain and inferior QoL after both rectal and colonic cancer resection.

KW - Colectomy

KW - Constipation/epidemiology

KW - Cross-Sectional Studies

KW - Diabetes Mellitus, Type 2/complications

KW - Humans

KW - Neoplasm Recurrence, Local

KW - Pain

KW - Postoperative Complications/epidemiology

KW - Quality of Life

KW - Rectal Neoplasms

KW - Syndrome

UR - http://www.scopus.com/inward/record.url?scp=85136418064&partnerID=8YFLogxK

U2 - 10.1093/bjsopen/zrac095

DO - 10.1093/bjsopen/zrac095

M3 - Journal article

C2 - 35998089

AN - SCOPUS:85136418064

SN - 2474-9842

VL - 6

JO - BJS Open

JF - BJS Open

IS - 4

M1 - zrac095

ER -