ASSOCIATION OF DIABETIC STATUS IN PATIENTS OF PANCREATIC DUCTAL ADENOCARCINOMA AND TO STUDY EFFECT OF TUMOR RESECTION ON DIABETIC STATUS
Rajesh Gupta*, Dinesh K. Bhuria, Vikas Gupta, Harjeet Singh, Surinder S. Rana, Ritambhra Nada, Dr. Sanjay Bhadada
Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
Introduction: Pancreatic cancer and diabetes mellitus (DM) are strongly associated. Recent-onset DM (RODM) resolved in more than half after pancreatico-duodenectomy. Objectives: This study aimed to assess the prevalence of diabetes mellitus in pancreatic ductal adenocarcinoma in North Indian population, and the postoperative course. This study also aimed to assess whether there was a change in diabetic status after tumor resection and comparison of postoperative course between diabetic and nondiabetic patients for 3 months postoperatively. Methodology: All patients of PDAC were screened for diabetes mellitus. Diabetic patients were further labelled as type II DM if DM was present for more than three years and recent-onset DM (RODM) if diagnosed within three years of diagnosis. Patients who underwent resection were assessed intra-operatively for pancreatic architecture, size of pancreatic duct, intra-operative blood loss, operative time, and postoperative histology and these factors were compared between diabetic and nondiabetic patients. Postoperative complications, length of postoperative stay and 90 days mortality were also compared between both groups. Results: Sixty-three patients with clinical diagnosis suggestive of PDAC were included. 11 patients were excluded because of different post-operative tumor sites or histopathology. Amongst the remaining 52 patients, 28 had Diabetes mellites, out of which 18 had RODM, and 10 had longstanding DM. T1 and T2 stages were more common in non-diabetic patients while T3 and T4 stages were more common in diabetics. M1 stage was more common in diabetic patients. 30/52 patients were clinically resectable on imaging, while 15 patients were unresectable and 7 patients had metastasis. 20 patients underwent surgery, out of which 9 were diabetic. 7/9 underwent resection and all were RODM. Tumor differentiation, positive LN, resection margin, LVI and PNI were not significantly different in both the groups. 13.33% patients developed POPF (Grade A) while 33.33% patients developed postoperative DGE (p=0.505). 80% patients with R1 status had diabetes, and 20% patient were non-diabetic (0.067). 3/20 patients had 90 days mortality. Postoperatively3/7 patients did not require any medication, while three required OHA and one required Insulin. Conclusion: Diabetes was present in majority of patients in present study. RODM was more common in PDAC compared to long standing DM. PDAC patients with DM was associated with increased tumor size and metastasis. Preoperative DM in PDAC did not impact perioperative outcomes significantly. Preoperative DM was not associated with an increased risk of pancreatic fistula formation and DGE after pancreaticoduodenectomy. Diabetic status after tumor resection improved at six weeks and three months postoperatively.
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