Prevalence of New-Onset Diabetes in Patients Undergoing Pancreatic Surgery and the Association of Glucose Dysregulation With Complications in Pancreatic Cancer.

Abstract

Objective: To determine the prevalence of new-onset diabetes (NOD) in individuals undergoing pancreatic surgery and to explore the implications of glycaemic status on clinicopathological features and outcomes for patients with pancreatic ductal adenocarcinoma (PDAC).

Introduction: PDAC is characterized by a high prevalence of NOD. The prevalence of NOD in individuals undergoing pancreatic surgery for other diseases is less well-documented.

Methods: A retrospective analysis of 483 individuals undergoing pancreatic surgery between 2016 and 2020 was undertaken. For patients with PDAC, associations between glycaemic status and tumor size, cancer stage, grade, postoperative complications, and outcomes were assessed.

Results: Diabetes status was determined for 433 patients. The prevalence of preoperative NOD was higher in PDAC (34.9%; 58/166) compared to ampullary adenocarcinoma (6.3%; 3/48; P < 0.001), cholangiocarcinoma (5.6%; 2/36; P < 0.001), and intraductal papillary mucinous neoplasms (8.9%; 4/45; P = 0.005), but was similar to chronic pancreatitis (30%; 9/30; P = 0.909). For 22/58 (37.9%) PDAC patients with NOD, diabetes was undiagnosed until preoperative testing. In individuals undergoing pancreaticoduodenectomy, delayed gastric emptying (DGE) was more frequently associated with glucose dysregulation than with normoglycaemia (32.8% vs 8.3%; P = 0.004), while overall postoperative pancreatic fistula (POPF) was less frequently associated with glucose dysregulation than with normoglycaemia (4.7% vs 19.4%; P = 0.02).

Conclusions: In contrast to PDAC, NOD was infrequently observed in other pancreatic/periampullary tumors. Of clinical importance, in more than one-third of PDAC patients, NOD was undiagnosed until preoperative assessment. Preoperative glucose dysregulation correlated with an increased rate of DGE and a reduced rate of POPF in pancreaticoduodenectomy.