Preoperative insulin resistance, indicated by HOMA-IR ≥ 2.5, was independently associated with an increased risk of anastomotic leakage (OR 2.95) after colorectal cancer resection.
Cohort (n=1,026)
Yes
Does preoperative insulin resistance increase the risk of anastomotic leakage in patients undergoing colorectal cancer resection?
Preoperative insulin resistance, as measured by HOMA-IR and TyG index, is independently associated with an increased risk of anastomotic leakage after colorectal cancer resection.
Effect estimate: OR 2.95 (95% CI 1.75-4.16)
Anastomotic leakage (AL) is a serious complication after colorectal cancer (CRC) surgery. Preoperative insulin resistance (IR) may impair anastomotic healing, but there is limited evidence regarding currently available surrogate markers of IR. In this multicenter retrospective cohort study conducted across three tertiary institutions between 2019 and 2024, 1,026 patients who underwent CRC resection with primary anastomosis were analyzed, of whom 128 (12.5%) developed AL. Preoperative IR was assessed with the use of the homeostasis model assessment of insulin resistance (HOMA-IR) and the triglyceride-glucose (TyG) index. The associations were evaluated using multivariable logistic regression adjusting for demographic, clinical, tumor-related, operative, and laboratory covariates. The TyG index cut-off was derived using receiver operating characteristic (ROC) analysis and internally validated using bootstrap resampling and cross-validation. Patients with AL had higher fasting insulin and HOMA-IR, and IR was more common in the AL group (60.9% vs. 31.1%). The TyG index was also higher in patients with AL, and TyG index ≥ 8.51 was more frequent in the AL group (63.3% vs. 45.5%). In multivariable logistic regression, HOMA-IR ≥ 2.5 (OR 2.95, 95% CI 1.75–4.16) and TyG index ≥ 8.51 (OR 1.58, 95% CI 1.08–2.09) remained independently associated with AL after adjustment for relevant demographic, tumor-related, operative, and laboratory covariates. Preoperative HOMA-IR and TyG index were associated with an increased risk of AL after CRC resection. Further prospective and externally validated studies are needed before routine clinical application can be considered. Retrospectively registered.
Shamohammadi et al. (Thu,) conducted a cohort in Colorectal cancer (n=1,026). Preoperative insulin resistance (HOMA-IR ≥ 2.5) vs. HOMA-IR < 2.5 was evaluated on Postoperative anastomotic leakage within 90 days (OR 2.95, 95% CI 1.75-4.16). Preoperative insulin resistance, indicated by HOMA-IR ≥ 2.5, was independently associated with an increased risk of anastomotic leakage (OR 2.95) after colorectal cancer resection.