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Back to 2014 Annual Meeting Abstracts
The Incidence of Pancreatogenic Diabetes After Major Partial Pancreatic Resection May Be Greater Than You Think
Richard a. Burkhart*1, Susan M. Gerber2, Renee Tholey1, Kathleen Lamb1, Anitha Somasundaram2, Caitlin Mcintyre1, Eliza Fradkin2, Annie Ashok2, Robert Felte1, Jaya Mehta2, Ernest L. Rosato1, Harish Lavu1, Serge a. Jabbour2, Charles J. Yeo1, Jordan M. Winter1
1Surgery, Thomas Jefferson University, Philadelphia, PA; 2Endocrinology, Thomas Jefferson University, Philadelphia, PA
Background: The number of pancreatic resections performed each year in the United States according to the Nationwide Inpatient Sample is growing (currently around 5000). Nearly half of the patients undergoing resection (many with benign disease) will experience prolonged survival (>2 years), yet the long-term risk of pancreatogenic (type III) diabetes remains unknown. Previous estimates from small studies outside of the U.S. suggest a risk between 10-20%.
Methods: After IRB approval, 1107 patients were identified who underwent pancreatectomy at a single institution from 2005 to 2012. Living patients were contacted by telephone, and pre- and postoperative diagnoses of diabetes mellitus (DM) were confirmed using a verbal questionnaire. Only individuals who completed the survey were included in the study.
Results: Calls were made to all 691 living patients who underwent partial pancreatectomy. DM-specific information was successfully obtained for 257 patients (23% of the total cohort), including 179 pancreaticoduodenectomies (PD) and 78 distal pancreatectomies (DP).
In the PD group: 44 (25%) patients reported having DM prior to resection (median onset 7 years prior, range 0.1 to 30), with 10 (6%) reporting onset within 1 year of resection. Of the group carrying a pre-operative diagnosis of DM, 3 (7%) had improved glucose control after resection (dose reduction in DM medicines), while 21 (48%) required escalated doses/medicines. Of 135 patients without preoperative DM, 24 (18%) were newly diagnosed with DM postoperatively (median onset 7.5 months postoperatively, range 1-64).
In the DP group: 23 patients (29%) had DM preoperatively, with just 4 having onset within 1 year of resection (5%). No patients had improved glucose control after resection, while 6 (26%) patients carrying a preoperative diagnosis of DM had worse control after resection. Out of 55 patients without preoperative DM, 17 (31%) developed new onset DM after resection (median 6 months, range 0-60).
In the total cohort of patients who developed DM after resection (n=41), the most common pathologic diagnoses at the time of resection were ductal adenocarcinoma (36%), IPMN adenoma (28%), and chronic pancreatitis (8%). Out of 190 patients without a diagnosis of preoperative DM, a high preoperative HgbA1C level (> 6%) was associated with an increased risk of developing new-onset DM post-resection (38% of patients in the >6% group vs. 11% in the ≤6% group, p<0.02).
Conclusions: Twenty-six percent of patients undergoing partial pancreatectomy experience new onset DM (22%) and/or worsening DM after resection (40%), a higher percentage of patients than previously reported. With a median follow-up time of 2.1 years after resection in this patient cohort, these figures may still underestimate the incidence of pancreatogenic diabetes. A high preoperative HgbA1C >6% identifies patients at highest risk. Incidence of perioperative DM with partial pancreatectomy | PD | DP | Total | | Non-diabetics: New onset DM postop | 24/135 (18%) | 17/55 (31%) | 41/190 (22%) | | Diabetics: Worse glucose control postop | 21/44 (48%) | 6/23 (26%) | 27/67 (40%) | | Total cohorts: New onset or worse control | 45/179 (25%) | 23/78 (29%) | 68/257 (26%) | | | | |
DM=diabetes mellitus, PD=pancreaticoduodenectomy, DP=distal pancreatectomy
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