diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13439diaendo-13439Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESФакторы риска и клиническое значение сахарного диабета, развившегося после панкреатодуоденальной резекции у больных раком поджелудочной железыRisk factors and clinical significance of diabetes mellitus developed after pancreaticoduodenectomy for pancreatic cancerhttps://orcid.org/0000-0002-6603-1390ЕгоровВ. И.EgorovV. I.

Егоров Василий Иванович, к.м.н.

420012, Казань, улица Бутлерова, д. 49 

Vasiliy I. Egorov, PhD

49 Butlerova street, 420012 Kazan

drvasiliy21@gmail.comhttps://orcid.org/0000-0002-2811-0549КотельниковА. Г.KotelnikovA. G.

Котельников Алексей Геннадьевич, д.м.н., профессор 

Москва

Aleksey G. Kotelnikov, MD, PhD, Professor

Moscow

kotelnikovag@mail.ruhttps://orcid.org/0000-0001-9254-1346ПатюткоЮ. И.PatyutkoYu. I.

Патютко Юрий Иванович, д.м.н., профессор

Москва

Yury I. Patyutko, MD, PhD, Professor

Moscow

mikpat@mail.ruhttps://orcid.org/0000-0002-4516-1997АхметзяновФ. Ш.AkhmetzyanovF. Sh.

Ахметзянов Фоат Шайхутдинович, д.м.н., профессор

Казань

Foat Sh. Akhmetzyanov, MD, PhD, Professor

Kazan

akhmetzyanov@mail.ruhttps://orcid.org/0000-0001-5348-5011ПоляковА. Н.PolyakovA. N.

Поляков Александр Николаевич, д.м.н.

Москва

Alexander N. Polyakov, PhD

Moscow

dr.alexp@gmail.comhttps://orcid.org/0000-0003-0504-585XКудашкинН. Е.KudashkinN. E.

Кудашкин Николай Евгеньевич, к.м.н. 

Москва

Nikolay E. Kudashkin, PhD

Moscow

dr.kudashkin@mail.ruКазанский государственный медицинский университет; Республиканский клинический онкологический диспансер Министерства здравоохранения Республики Татарстан имени профессора М.З. СигалаРоссияKazan State Medical University; Republican Clinical Oncology Dispensary named after prof. M.Z. SigalRussian FederationНациональный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияThe N.N. Blokhin National Medical Research Center of OncologyRussian FederationКазанский государственный медицинский университет; Республиканский клинический онкологический диспансер Министерства здравоохранения Республики Татарстан имени профессора М.З. СигалаРоссияKazan State Medical University; Republican Clinical Oncology Dispensary  named after prof. M.Z. SigalRussian Federation202601102026294314324Copyright © Егоров В.И., Котельников А.Г., Патютко Ю.И., Ахметзянов Ф.Ш., Поляков А.Н., Кудашкин Н.Е., 20262026Егоров В.И., Котельников А.Г., Патютко Ю.И., Ахметзянов Ф.Ш., Поляков А.Н., Кудашкин Н.Е.Egorov V.I., Kotelnikov A.G., Patyutko Y.I., Akhmetzyanov F.S., Polyakov A.N., Kudashkin N.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13439ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Сахарный диабет (СД) является клинически значимым отдаленным осложнением панкреатодуоденальной резекции (ПДР), однако его частота, факторы риска его развития и влияние на онкологические исходы остаются недостаточно изученными.

ЦЕЛЬ

ЦЕЛЬ. Оценить факторы риска СД, развившегося после ПДР у больных раком поджелудочной железы и определить его клиническое значение.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Проведено двуцентровое ретроспективное когортное исследование, включавшее 544 пациентов, перенесших ПДР в 2011–2024 гг. Анализировались клинико-демографические, интраоперационные и морфологические параметры. Для выявления предикторов СД и оценки выживаемости использовались однофакторный и многофакторный регрессионные анализы. Прогностическая способность модели оценивалась с помощью ROC-анализа. 

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Общая частота СД среди пациентов, перенесших ПДР, без исходного СД составила 15,3% (83/544). Независимыми предикторами развития СД были: возраст 67 лет и выше (OR 1,069; 95% ДИ 1,029–1,110; p=0,001), стенокардия напряжения (OR 2,554; 95% ДИ 1,172–5,562; p=0,018), диаметр вирсунгова протока (0,5 см и выше) (OR 5,84; 95% ДИ 1,399–24,45; p=0,016), осложнения по шкале Clavien–Dindo ≥ III-A (OR 8,9; 95% ДИ 3,9–20,3; p<0,001), острый панкреатит культи (OR 13,03; 95% ДИ 1,3–121,8; p=0,024), неоадъювантная химиотерапия (OR 2,695; 95% ДИ 1,317–5,518; p=0,007). Прогностическая модель показала высокую дискриминационную способность (AUC=0,833). В подгруппе оперированных по поводу протокового рака головки поджелудочной железы ранний СД, развившийся в первые 90 дней после операции, был независимым фактором худшей общей выживаемости (HR 3,419; 95% ДИ 1,307–8,939; p=0,012), в то время как поздний СД на отдаленный прогноз не влиял.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. СД после ПДР по поводу рака головки поджелудочной железы и органов периампуллярной зоны является относительно редким (15,3%), но клинически значимым осложнением. Необходима предоперационная оценка риска данного осложнения и тщательный послеоперационный метаболический мониторинг.

BACKGROUND

BACKGROUND: Diabetes mellitus (DM) is a clinically significant long-term complication of pancreatoduodenectomy (PD); however, its incidence, risk factors for its development, and its impact on oncological outcomes remain insufficiently studied.

AIM

AIM: To evaluate risk factors for diabetes mellitus in patients undergoing pancreatoduodenectomy and to determine its clinical significance.

MATERIALS AND METHODS

MATERIALS AND METHODS: A two-center retrospective cohort study was conducted, including 544 patients who underwent PD between 2011 and 2024. Clinical, demographic, intraoperative, and morphological parameters were analyzed. Univariate and multivariate regression analyses were used to identify predictors of DM and to assess survival. The predictive performance of the model was evaluated using ROC analysis.

RESULTS

RESULTS: The overall incidence of DM among patients without pre-existing diabetes mellitus was 15.3% (83/544). Independent predictors for the development of DM were: age 67 years and older (OR 1.069; 95% CI: 1.029–1.110; p=0.001), stable angina pectoris (OR 2.554; 95% CI: 1.172–5.562; p=0.018), diameter of the Wirsung duct (≥0.5 cm) (OR 5.84; 95% CI: 1.399–24.45; p=0.016), complications of Clavien–Dindo grade ≥ IIIA (OR 8.9; 95% CI: 3.9–20.3; p<0.001), acute stump pancreatitis (OR 13.03; 95% CI: 1.3–121.8; p=0.024), and neoadjuvant chemotherapy (OR 2.695; 95% CI: 1.317–5.518; p=0.007). The prognostic model demonstrated high discriminatory ability (AUC = 0.833). In the subgroup of patients operated on for pancreatic ductal adenocarcinoma of the head of the pancreas, early DM, developed within the first 90 days after surgery, was an independent factor for worse overall survival (HR 3.419; 95% CI: 1.307–8.939; p=0.012), while late DM did not affect long-term prognosis.

CONCLUSION

CONCLUSION: Diabetes mellitus following pancreatoduodenectomy for pancreatic head and periampullary cancers is a relatively uncommon (15.3%) but clinically significant complication. Preoperative assessment of the risk for this complication and careful postoperative metabolic monitoring are necessary.

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The authors declare that there are no conflicts of interest present.