Significance of Pancreatic Steatosis as a Predictor of New-Onset Diabetes Mellitus Following Pancreatectomy.

Abstract

Background: Despite advancements in pancreatic surgery, new-onset diabetes mellitus following pancreatectomy (NODMP), persists, affecting patients' quality of life. Predicting NODMP before surgery could significantly enhance postoperative care.

Methods: This study included 220 patients who underwent pancreatoduodenectomy or distal pancreatectomy at Hirosaki University Hospital between January 2008 and December 2020. Patients with preoperative diabetes or <6 months' follow-up were excluded. The anticipated remnant pancreatic-to-splenic parenchyma computed tomography value ratio (remP/S ratio) was used to assess pancreatic fat content, with its cutoff determined using the receiving operator characteristic curve. Time to diabetes onset was analyzed using the Kaplan-Meier method. The risk factors for NODMP were identified using the Cox proportional hazards model.

Results: The mean diabetes-free period was 89.2 months over a median follow-up of 25.1 months. The incidence rates of NODMP at 1, 3, and 5 years after resection were 7.21%, 21.3%, and 28.0%, respectively. The significant risk factors for NODMP identified by univariate analysis were pancreatic cancer, preoperative HbA1c >5.7%, remP/S ratio <0.66, and remnant pancreatic volume <32.7 cm3. Multivariate analysis confirmed that a remP/S ratio <0.66 and preoperative HbA1c >5.7% were independent predictors of NODMP. The risk scoring system indicated that patients with both risk factors have a fivefold higher risk of developing NODMP within 2 years compared with those without either risk factor.

Conclusions: Preoperative remP/S ratio and HbA1c were significant predictors of NODMP, enabling the effective stratification of NODMP risk and facilitating the early treatment of the disease.