New-onset diabetes after distal pancreatectomy-findings from a national cohort study

Pancreatic resection is associated with a high frequency of postoperative new-onset diabetes mellitus (NODM). The present study aimed to quantify the rate and investigate potential risk factors for NODM after distal pancreatectomy.

Data on patients undergoing distal pancreatectomy between 2010 and 2020 were obtained from the Swedish National Pancreatic and Periampullary Cancer Registry and cross-referenced with the Swedish National Diabetes Register. Uni- and multivariable competing risk regression analyses were conducted to model sub-distribution hazards (SHR) of NODM between groups.

A total of 1,034 patients were included, with 290 (28%) developing NODM postoperatively. The risk of NODM was reduced for female patients (SHR 0.73, p = 0.014) and those in the minimally invasive surgery group (SHR 0.54, p = 0.002). Conversely, the risk was increased for obese patients (SHR 2.23, p < 0.001), older patients (SHR 1.01, p = 0.006), patients with American Society of Anesthesiologists classifications 2 and 3 (SHR 2.03, p < 0.001 and SHR 1.61, p = 0.037, respectively), and those with benign pancreatic tumors (SHR 1.43, p = 0.020).

NODM was common among patients after distal pancreatectomy, with several patient and surgical factors influencing risk. A minimally-invasive approach was associated with a lower risk of NODM after surgery. This association warrants further study, but should be interpreted cautiously due to potential selection bias and residual confounding, but it warrants further study.