Schranz Anna, Sternad Christoph, Aziz Faisal, Wagner Doris, Kornprat Peter, Sucher Robert, Jost Philipp J, Wölfler Albert, Pieber Thomas R, Sourij Harald, Riedl Jakob M, Aberer Felix
Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria.
Department of Surgery, Medical University of Graz, 8036 Graz, Austria.
J Clin Med. 2023 Dec 6;12(24):7532. doi: 10.3390/jcm12247532.
Diabetes mellitus (DM) is a prominent risk factor for malignant and non-malignant pancreatic diseases. Furthermore, the presence of DM predicts an unfavourable outcome in people with pancreatic cancer. This retrospective observational study investigated 370 patients who underwent pancreatic resection surgery for various indications (84.3% in malignant indication) in a single surgery centre in Graz, Austria. The preoperative and postoperative diabetes statuses were evaluated according to surgery method and disease entity and predictors for diabetes development after surgery, as well as outcomes (survival and cancer recurrence) according to diabetes status, were analysed. In the entire cohort, the postoperative diabetes (postopDM) incidence was 29%. PostopDM occurred significantly more frequently in malignoma patients than in those with benign diseases (31.3% vs. 16.7%; = 0.040, OR = 2.28). In the malignoma population, BMI, longer surgery duration, and prolonged ICU and hospital stay were significant predictors of diabetes development. The 1- and 2-year follow-ups showed a significantly increased mortality of people with postopDM in comparison to people without diabetes (HR 1-year = 2.02, = 0.014 and HR 2-years = 1.56, = 0.034). Local cancer recurrence was not influenced by the diabetes status. Postoperative new-onset diabetes seems to be associated with higher mortality of patients with pancreatic malignoma undergoing pancreatobiliary surgery.
糖尿病(DM)是恶性和非恶性胰腺疾病的一个突出危险因素。此外,DM的存在预示着胰腺癌患者的不良预后。这项回顾性观察研究调查了奥地利格拉茨一个单一手术中心的370例因各种适应症接受胰腺切除术的患者(恶性适应症患者占84.3%)。根据手术方法和疾病实体评估术前和术后的糖尿病状态,并分析术后糖尿病发生的预测因素,以及根据糖尿病状态分析的预后(生存和癌症复发)。在整个队列中,术后糖尿病(postopDM)的发生率为29%。恶性肿瘤患者中postopDM的发生频率明显高于良性疾病患者(31.3%对16.7%;P = 0.040,OR = 2.28)。在恶性肿瘤人群中,BMI、手术时间延长以及ICU和住院时间延长是糖尿病发生的重要预测因素。1年和2年的随访显示,与无糖尿病患者相比,postopDM患者的死亡率显著增加(1年HR = 2.02,P = 0.014;2年HR = 1.56,P = 0.034)。局部癌症复发不受糖尿病状态的影响。术后新发糖尿病似乎与接受胰胆手术的胰腺恶性肿瘤患者的较高死亡率有关。