Impact of diabetes mellitus on morbidity and survival after pancreaticoduodenectomy for malignancy

Kunal Bikram Deo; Aditya Atul Kulkarni; Praveen Kumar-M; Gautham Krishnamurthy; Sunil Shenvi; Surinder Singh Rana; Rakesh Kapoor; Rajesh Gupta

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자료유형: 학술저널

저자정보: Kunal Bikram Deo (Postgraduate Institute of Medical Education and Research (PGIMER)) Aditya Atul Kulkarni (Postgraduate Institute of Medical Education and Research (PGIMER)) Praveen Kumar-M (Postgraduate Institute of Medical Education and Research (PGIMER)) Gautham Krishnamurthy (Postgraduate Institute of Medical Education and Research (PGIMER)) Sunil Shenvi (Postgraduate Institute of Medical Education and Research (PGIMER)) Surinder Singh Rana (Postgraduate Institute of Medical Education and Research (PGIMER)) Rakesh Kapoor (Postgraduate Institute of Medical Education and Research (PGIMER)) Rajesh Gupta (Postgraduate Institute of Medical Education and Research (PGIMER))

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제25권 제2호

발행연도: 2021.5

수록면: 230 - 241 (12page)

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Backgrounds/Aims: Diabetes mellitus (DM) is a known risk factor for morbidity, length of hospital stay, or mortality after surgery, however, its impact on postoperative course and long-term survival after pancreaticoduodenectomy (PD) is not clear. Methods: This is a retrospective analysis of prospectively maintained database of 141 patients with periampullary and pancreatic head adenocarcinoma operated between January 2001 and March 2019. Clinico-pathological records and follow-up data were retrieved and analyzed. Cumulative hazard was computed for comparing the survival between DM and non-DM. Results: DM was present in 31/141 (21.9%) patients, while 16/31 (51.6%). were new-onset DM (NODM). Tumor size, lymphovascular & perineural invasion, type of surgery, lymph node positivity and R0 resection rate were comparable between diabetic and non-diabetic. There was no significant difference in postoperative pancreatic fistula, delayed gastric emptying, infectious complication, hospital stay and mortality between DM and non-diabetics. Patients with DM had worse survival at 3 years (OS: HR, 3.11 [1.43-6.76] p=0.004, DFS: HR, 2.61 [1.23-5.53] p=0.01) and 5 years (OS: HR, 3.32 [1.46-7.53] p=0.004, DFS: HR, 2.87 [1.29-6.41] p=0.009). On multivariate analysis, DM (3 year OS: HR, 2.61 [1.14-5.98] p=0.022, DFS: HR, 2.19; p=0.058) (5 year OS: HR, 2.55; p=0.04, DFS: HR, 2.25; p=0.068) and pylorus resecting surgery were significantly associated with worse survival at 3 and 5 years. Conclusions: Preoperative DM has no significant effect on postoperative course but has negative impact on 3-year and 5-year OS and DFS after PD for pancreatic and periampullary adenocarcinoma.

#Pancreaticoduodenectomy #Periampullary carcinoma #Pancreatic adenocarcinoma #Diabetes mellitus #Survival analysis

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