Diabetes mellitus, glycemic control, and risk of postoperative infectious complications in gastric and colorectal cancer surgery

Abstract

The rising global prevalence of diabetes mellitus increasingly affects outcomes in gastrointestinal surgery. Patients undergoing gastric or colorectal cancer surgery often present with metabolic comorbidities that may compromise postoperative recovery. The study from Peng et al on the issue of World Journal of Gastrointestinal Surgery, highlights that a history of diabetes and poor glycemic control, reflected by elevated glycated hemoglobin levels, are significant predictors of postoperative infectious complications, including surgical site infections and systemic infections. Hypoalbuminemia was also identified as an independent risk factor, emphasizing the interplay between metabolic status and nutritional reserves. Chronic hyperglycemia impairs immune function, collagen synthesis, and tissue perfusion, directly compromising anastomotic integrity and increasing the risk of surgical site infections, while surgical stress further exacerbates perioperative metabolic imbalance. These findings underscore the importance of comprehensive preoperative metabolic assessment, strict perioperative glycemic management, and nutritional optimization to reduce postoperative morbidity in diabetic patients undergoing gastrointestinal cancer surgery.

Keywords: Diabetes mellitus; Gastric cancer; Colorectal cancer; Postoperative complications; Surgical site infection; Glycemic control; Anastomotic leak

Core Tip: Diabetes mellitus and perioperative hyperglycemia significantly increase the risk of infectious complications and anastomotic failure in gastrointestinal surgery. The recent findings by Peng et al underscore that preoperative glycated hemoglobin levels and albumin status are essential biomarkers for risk stratification. Beyond systemic infections, metabolic dysfunction directly impairs collagen synthesis, linking hyperglycemia to surgical site infections and micro-leaks. Surgeons must adopt a multidisciplinary approach focused on glycemic control and nutritional optimization to mitigate these risks in the growing population of diabetic oncologic patients.