Does the pancreatic volume reduction rate using serial computed tomographic volumetry predict new onset diabetes after pancreaticoduodenectomy?

Abstract

Volume reduction of the pancreatic tissues following a pancreatectomy can lead to the deterioration of glucose homeostasis. This is defined as pancreatogenic diabetes mellitus (DM). The objective of this study was to investigate the occurrence of new-onset DM (NODM) and evaluate the risk factors, including the pancreas volume reduction rate in patients undergoing pancreaticoduodenectomy (PD).Sixty-six patients without preoperative DM underwent PD for periampullary tumors between August 2007 and December 2012 and were included in this analysis. These patients underwent follow-up tests and abdominal computed tomography (CT) scan 7 days, 6 months, 12 months, 24 months, and 36 months after the operation. The pancreas volume reduction rate was calculated by CT volumetry. The patients were divided into 2 groups according to the postoperative development of DM.After PD, newly diagnosed DM occurred in 16 patients (24.2%). The incidence of DM was highest among patients with carcinomas with an advanced T stage. The pancreatic volume reduction rate after 6 and 12 months in the NODM group was significantly higher than the normal glucose group in the univariate analysis. In the multivariate analysis, the pancreatic volume reduction rate 6 months after PD was the only significant predictive factor for the development of NODM (P = 0.002).This study suggests that the pancreatic volume reduction rate 6 months after PD was the only significant predictive factor for the development of NODM. CT volumetry of the pancreas may be useful as a predictor of NODM after PD.

Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review

“…Multivariate analysis conducted by Kwon et al in a study population of 225 patients found that patients who were obese (BMI ≥ 25) had increased risk of developing DM post pancreatectomy (OR 1.25; (95% CI: 1.09‐1.43; P = .001). No significant differences were found in the incidence of obesity between DM and non‐DM groups in the remaining studies that assessed for this …”

“…Bock et al found the DM group to be significantly younger than the patients that did not develop DM, whilst Kwon et al found the DM group significantly older. Hwang et al, Kang et al, Shirakawa et al, Wu et al, You et al and Yun et al found no significant differences in age between the two groups.…”

“…Kwon et al found that those who developed DM post operatively had a significantly larger resected volume ratio compared to the nonaffected group. Conversely, Yun et al found that there was no significant difference in the volume of pancreas that was resected between those that developed DM and those that did not. However, this study did find a significantly higher rate of pancreatic volume reduction in the residual pancreas at 6 and 12 months in the new‐onset DM group compared to the nonaffected group (60.75 ± 10.05% vs 70.35 ± 11.02%, at 12 months, P = .003).…”

“…Sample sizes in individual studies ranged from 20 to 4775 patients, with a total of 9970 patients included for analysis. Table summarizes the study characteristics and key results for the included studies . These studies included 5636 patients undergoing pancreaticoduodenectomy, 3922 patients with distal pancreatectomy and 315 undergoing central pancreatectomy.…”

“…Forest plot of studies indicating incidence of new‐onset DM after each type of resection. A, Pancreaticoduodenectomy . Random effects model.…”