Diabetes after pancreaticoduodenectomy: can we predict it?

J Surg Res. 2018 Jul;227:211-219. doi: 10.1016/j.jss.2018.02.010. Epub 2018 Mar 20.

Abstract

Background: There is limited literature about the perioperative factors which can predict endocrine insufficiency after pancreaticoduodenectomy (PD). The primary aim was to correlate percentage pancreatic remnant volume (%RV) after PD in nondiabetic patients with the development of new-onset impaired glucose tolerance/diabetes mellitus (IGT/DM). The secondary aim was to identify the risk factors for new-onset IGT/DM.

Methods: In this prospective study, all consecutive patients with resectable periampullary carcinoma and without IGT/DM were evaluated with fasting and postprandial plasma glucose, HbA1c, insulin, and C-peptide levels preoperatively and at 3 mo postoperatively. After that, all patients were followed up with fasting and postprandial plasma glucose level assessed at 3-mo intervals for 24 mo or till death, whichever occurred earlier. The %RV was determined from computed tomography measurements preoperatively.

Results: Of the 50 patients, 11 (22%) patients developed IGT/DM after median follow-up of 32 mo. The patients' with/without IGT/DM were similar in demographic/perioperative variables. The %RV was found to be an independent factor associated with new-onset IGT/DM. A %RV of <48.8% was found to be a predictor of new-onset IGT/DM (sensitivity, 89.7%; specificity, 73.6%). Plasma sugar and glycosylated hemoglobin levels were significantly higher postoperatively after PD than the preoperative levels. Insulin and C-peptide levels were significantly lower after PD, irrespective of new-onset IGT/DM.

Conclusions: The incidence of IGT/DM after PD was 22%, and %RV < 48.8% was found to be a significant risk factor for new-onset IGT/DM. (CTRI/2013/12/004233).

Keywords: Diabetes; Endocrine insufficiency; Pancreatic resection; Pancreatic volume; Pancreaticoduodenectomy; Pancreatoduodenectomy; Type III diabetes.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Bile Duct Neoplasms / blood
  • Bile Duct Neoplasms / diagnostic imaging
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery
  • Blood Glucose / analysis
  • Carcinoma / blood
  • Carcinoma / diagnostic imaging
  • Carcinoma / pathology
  • Carcinoma / surgery
  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / etiology
  • Duodenal Neoplasms / diagnostic imaging
  • Duodenal Neoplasms / pathology
  • Duodenal Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Glucose Intolerance / diagnosis*
  • Glucose Intolerance / epidemiology
  • Glucose Intolerance / etiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Organ Size
  • Pancreas / diagnostic imaging
  • Pancreas / pathology
  • Pancreas / surgery
  • Pancreatic Neoplasms / blood
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / methods
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Period
  • Prognosis
  • Prospective Studies
  • Tomography, X-Ray Computed

Substances

  • Blood Glucose