Risk factors for pancreatogenic diabetes after pancreaticoduodenectomy

Postoperative diabetes mellitus (DM) after pancreaticoduodenectomy (PD) may compromise the long-term quality of life in survivors after the operative procedure due to the treatment difficulty and its related complications. The aim of this study is to determine the incidence of new-onset pancreatogenic DM after PD and investigate the risk factors for this complication.

Among 170 patients who had undergone PD between November 2003 and September 2009, 98 patients were selected for this study. The selected patients were non-diabetic prior to the operation and had undergone follow-up tests for glucose metabolism and an abdominal computed tomography (CT) scan 1 year after the operation. The clinical data of these patients were retrospectively analyzed by reviewing the medical records, radiologic images, and pathologic reports.

Postoperative pathology confirmed malignant tumors in 91 patients, borderline malignancy in 5, and benign tumor in 2. The tumor locations included the pancreatic head (n=30), the common bile duct (CBD) (n=30), ampulla of Vater (n=30), and the duodenum (n=8). New-onset DM occurred in 17 (17.4%) of the 98 patients during the first year after the operation. The comparative analysis between postoperative DM (+) and DM (-) groups revealed that the atrophy of the remaining pancreas was the only significant risk factor for development of postoperative DM after PD.

This study suggests that the atrophy of the remaining pancreas increases the risk of pancreatogenic DM after PD, and efforts to prevent pancreatic atrophy are needed to decrease this complication.