The Impact of Perioperative Blood Glucose Levels on Pancreatic Cancer Prognosis and Surgical Outcomes

Abstract

Although diabetes mellitus (DM) and pancreatic cancer (PC) are intricately linked, a comprehensive review addressing the impact of DM on PC prognosis and surgical outcomes is lacking. PubMed search was performed (1980-2012) using keywords "pancreatic cancer", "diabetes mellitus", "glucose intolerance", "pancreatic resection", "prognosis", and "post-operative outcomes". The search results were analyzed to determine the strength of association between DM and PC and to assess the impact of DM on PC prognosis and postoperative outcomes. Thirty-one studies involving 38,777 patients were identified. Patients with non-insulin-dependent DM have 1.5-2 fold increased relative risk of developing PC. Non-insulin-dependent DM is identified in 25.7% of patients with PC compared to 10.4% age-matched controls (95% confidence interval, 1.5-4.7; P < 0.0001). Patients with PC are more likely to have a diagnosis of new-onset DM than age-matched controls (14.7% vs 2.7%; P < 0.0001). Patients with PC with DM have a significantly lower overall survival than those without DM (14.4 vs 21.7 months; P < 0.001). The presence of DM significantly increases overall postoperative complication rates (45.6% vs 35.6%; P < 0.008). Patients with new-onset non-insulin-dependent DM are at a higher risk of developing PC and have a worse long-term survival and a higher rate of postoperative complications.

Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma

“…Pancreatic adenocarcinoma is frequently accompanied by atrophy and duct dilatation distal to the tumor, [26] and duct obstruction can interfere with pancreatic endocrine function and can cause DM. [12,14] There are reports that preoperative DM improved after PD in some patients, [10,12,30] supporting our data that the acute pancreatic duct dilatation caused by obstruction by pancreatic cancer is reversible. Another mechanical change that accompanies is the removal of tumor mass, which can secrete diabetogenic agent.…”

“…The causal relationship between pancreatic cancer and DM is unclear, although some evidence indicates DM caused by pancreatic cancer may be reversible after surgical resection. [30] In the present study, the prevalence of preoperative DM in all patients was 53.3%, which was more than twice as higher than values reported on mixed disease entities. [9,10,12] Considering that baseline serum glucose was measured during the immediate preoperative period, it is likely that so-called acute or new-onset DM cases caused by pancreatic cancer, whether by duct obstruction or tumor-related diabetogenic material, were included in the present study.…”

“…Another mechanical change that accompanies is the removal of tumor mass, which can secrete diabetogenic agent. [30] However, we could not observe the improvement of GTI after DP, although the tumors had been removed in both PD and DP groups. The causal relationship between pancreatic cancer and DM is unclear, although some evidence indicates DM caused by pancreatic cancer may be reversible after surgical resection.…”

“…[9,10,12] Considering that baseline serum glucose was measured during the immediate preoperative period, it is likely that so-called acute or new-onset DM cases caused by pancreatic cancer, whether by duct obstruction or tumor-related diabetogenic material, were included in the present study. [19,30] Our results show that such cases may exhibit improved pancreas endocrine function after removal of the tumor burden and amelioration of duct obstruction by surgical resection, [8] as evidenced by the evolution of GTI and PAI, and the disappearance of the correlation between GTI and RPV postoperatively. [28] DM is the hallmark of pancreatic endocrine insufficiency, and is a multifactorial entity that embraces volume-related factors, such as insulin and glucagon secreting abilities, and cancer-related factors, such as tumor burden and duct obstruction and dilatation.…”

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

“…Numerous studies have shown an association between new-onset non-insulin-dependent diabetes and the development of pancreatic cancer. [7][8][9] Therefore, newonset diabetes in an otherwise fit individual might prompt consideration of early-stage pancreatic cancer. Screening for this disease is generally only recommended for asymptomatic individuals at increased risk.…”