Risk factors and clinical significance of diabetes mellitus developed after pancreaticoduodenectomy for pancreatic cancer

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

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: 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: 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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