Abstract
Background
New-onset diabetes mellitus (DM) is associated with pancreatic ductal cell adenocarcinoma (PDCA) and can resolve after pancreaticoduodenectomy (PD). Whether DM also resolves after PD in patients operated for disease other than PDCA remains to be determined.
Methods
We compared glycemic status before and after PD between patients with and without PDCA by review of a prospectively maintained database including all patients receiving PD from 2005 to 2011. New-onset DM was defined as diagnosis of DM less than 24 months before PD, and cases with DM diagnosis ≥24 months preceding PD were described as long-standing DM.
Results
Of 458 patients receiving PD, there were 146 (31.9 %) PDCA and 312 (68.1 %) non-PDCA, including 160 benign diseases, 113 ampulla cancer, 29 distal common bile duct cancer, and 10 duodenal cancer. Overall prevalence of DM was higher in PDCA group than non-PDCA group (37.7 vs. 25.6 %; P = 0.011). Resolution of new-onset DM after PD was observed in 9 (41 %) of 22 patients with PDCA and in 12 (63 %) of 19 patients without PDCA. Resolution of long-standing DM after PD was also observed in 3 (9.1 %) of 33 patients with PDCA and in 6 (9.8 %) of 61 patients without PDCA.
Conclusions
DM resolved after PD in some patients both with and without PDCA. These findings suggest that PD-associated anatomic change may play a role in resolution of DM after PD.
Similar content being viewed by others
References
Ben Q, Cai Q, Li Z, Yuan Y, Ning X, Deng S, et al. The relationship between new-onset diabetes mellitus and pancreatic cancer risk: a case-control study. Eur J Cancer. 2011;47(2):248–54.
Pannala R, Leirness JB, Bamlet WR, Basu A, Petersen GM, Chari ST. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology. 2008;134(4):981–7.
Ohtsuka T, Kitahara K, Kohya N, et al. Improvement of glucose metabolism after a pancreaticoduodenectomy. Pancreas. 2009;38:700–5.
Nannipieri M, Mari A, Anselmino M, Baldi S, Barsotti E, Guarino D, et al. The role of beta-cell function and insulin sensitivity in the remission of type 2 diabetes after gastric bypass surgery. J Clin Endocrinol Metab. 2011;96(9):E1372–9.
Camastra S, Gastaldelli A, Mari A, Bonuccelli S, Scartabelli G, Frascerra S, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011;54(8):2093–102.
Falkén Y, Hellström PM, Holst JJ, Näslund E. Changes in glucose homeostasis after Roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab. 2011;96(7):2227–35.
Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009;35(6 Pt 2):518–23.
Slezak LA, Andersen DK. Pancreatic resection: effect on glucose metabolism. World J Surg. 2001;25:452–60.
Ishikawa O, Ohigashi H, Eguchi H, et al. Long term follow-up of glucose tolerance function after pancreaticoduodenectomy: comparison between pancreaticogastrostomy and pancreaticojejunostomy. Surgery. 2004;136:617–23.
Tien YW, Yang CY, Wu YM, Hu RH, Lee PH. Enteral nutrition and biliopancreatic diversion effectively minimize impacts of gastroparesis after pancreaticoduodenectomy. J Gastrointest Surg. 2009;13(5):929–37.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2007;30:S42–7.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al.; International Study Group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications—a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205.
Gullo L, Pezzilli R, Morselli-Labate AM; Italian Pancreatic Cancer Study Group. Diabetes and the risk of pancreatic cancer. N Engl J Med. 1994;331(2):81–4.
Noy A, Bilezikian JP. Clinical review 63: diabetes and pancreatic cancer: clues to the early diagnosis of pancreatic malignancy. J Clin Endocrinol Metab. 1994;79:1223–31.
Permert J, Ihse I, Jorfeldt L, von Schenck H, Arnqvist HJ, Larsson J. Pancreatic cancer is associated with impaired glucose metabolism. Eur J Surg. 1993;159(2):101–7.
Fogar P, Pasquali C, Basso D, et al. Diabetes mellitus in pancreatic cancer follow-up. Anticancer Res. 1994;14:2827–30.
Mingrone G, Castagneto GL. Mechanisms of early resolution of type 2 diabetes after bariatric surgery. Diabetes. 2009;35:518–23.
Hamilton L, Jeyarajah DR. Hemoglobin A1c can be helpful in predicting progression to diabetes after Whipple procedure. HPB (Oxf). 2007;9(1):26–8.
Jang JY, Kim SW, Park SJ, Park YH. Comparison of the functional outcome after pylorus-preserving pancreatoduodenectomy: pancreatogastrostomy and pancreatojejunostomy. World J Surg. 2002;26(3):366–71.
Fang WL, Su CS, Shyr YM, et al. Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy. Pancreas. 2007;35:361–5.
Acknowledgment
National Taiwan University Hospital (NCTRC201202) provided grant support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wu, JM., Kuo, TC., Yang, CY. et al. Resolution of Diabetes After Pancreaticoduodenectomy in Patients with and without Pancreatic Ductal Cell Adenocarcinoma. Ann Surg Oncol 20, 242–249 (2013). https://doi.org/10.1245/s10434-012-2577-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2577-y