Ann Hepatobiliary Pancreat Surg.  2021 May;25(2):230-241. 10.14701/ahbps.2021.25.2.230.

Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy

• Deo KB
• Kulkarni AA
• Kumar-M P
• Krishnamurthy G
• Shenvi S
• Rana SS
• Kapoor R
• Gupta R

• KMID: 2516244
• DOI: http://doi.org/10.14701/ahbps.2021.25.2.230

Abstract

Backgrounds/Aims
Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear.
Methods
This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM.
Results
DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and nondiabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years.
Conclusions
Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.

Keyword

Pancreaticoduodenectomy; Periampullary carcinoma; Pancreatic adenocarcinoma; Diabetes mellitus; Survival analysis

Figure

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  Fig. 1 Cumulative hazard plot showing 1, 3, and 5-year overall survival and disease-free survival for non-diabetes, long-standing DM, and new-onset DM. p values of each long standing and new onset DM are in comparison with non-diabetics. OS, overall survival; DFS, Disease free survival.

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