Stott Martyn, Stefanova Irena, Oldfield Lucy, Evans Anthony, Birch-Ford James, Rao Rohith, Greenhalf William, Halloran Christopher, Costello Eithne
From the Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
Department of Pancreatic Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK.
Ann Surg Open. 2025 Jun 11;6(2):e584. doi: 10.1097/AS9.0000000000000584. eCollection 2025 Jun.
To determine the prevalence of new-onset diabetes (NOD) in individuals undergoing pancreatic surgery and to explore the implications of glycaemic status on clinicopathological features and outcomes for patients with pancreatic ductal adenocarcinoma (PDAC).
PDAC is characterized by a high prevalence of NOD. The prevalence of NOD in individuals undergoing pancreatic surgery for other diseases is less well-documented.
A retrospective analysis of 483 individuals undergoing pancreatic surgery between 2016 and 2020 was undertaken. For patients with PDAC, associations between glycaemic status and tumor size, cancer stage, grade, postoperative complications, and outcomes were assessed.
Diabetes status was determined for 433 patients. The prevalence of preoperative NOD was higher in PDAC (34.9%; 58/166) compared to ampullary adenocarcinoma (6.3%; 3/48; < 0.001), cholangiocarcinoma (5.6%; 2/36; < 0.001), and intraductal papillary mucinous neoplasms (8.9%; 4/45; = 0.005), but was similar to chronic pancreatitis (30%; 9/30; = 0.909). For 22/58 (37.9%) PDAC patients with NOD, diabetes was undiagnosed until preoperative testing. In individuals undergoing pancreaticoduodenectomy, delayed gastric emptying (DGE) was more frequently associated with glucose dysregulation than with normoglycaemia (32.8% vs 8.3%; = 0.004), while overall postoperative pancreatic fistula (POPF) was less frequently associated with glucose dysregulation than with normoglycaemia (4.7% vs 19.4%; = 0.02).
In contrast to PDAC, NOD was infrequently observed in other pancreatic/periampullary tumors. Of clinical importance, in more than one-third of PDAC patients, NOD was undiagnosed until preoperative assessment. Preoperative glucose dysregulation correlated with an increased rate of DGE and a reduced rate of POPF in pancreaticoduodenectomy.
确定接受胰腺手术患者中新发糖尿病（NOD）的患病率，并探讨血糖状态对胰腺导管腺癌（PDAC）患者临床病理特征及预后的影响。
PDAC的特点是NOD患病率高。关于因其他疾病接受胰腺手术患者的NOD患病率，相关文献记载较少。
对2016年至2020年间接受胰腺手术的483例患者进行回顾性分析。对于PDAC患者，评估血糖状态与肿瘤大小、癌症分期、分级、术后并发症及预后之间的关联。
确定了433例患者的糖尿病状态。与壶腹腺癌（6.3%；3/48；<0.001）、胆管癌（5.6%；2/36；<0.001）和导管内乳头状黏液性肿瘤（8.9%；4/45；=0.005）相比，PDAC患者术前NOD的患病率更高，但与慢性胰腺炎（30%；9/30；=0.909）相似。对于58例NOD的PDAC患者中的22例（37.9%），糖尿病在术前检查时才被诊断出来。在接受胰十二指肠切除术的患者中，胃排空延迟（DGE）与血糖失调的相关性高于血糖正常者（32.8%对8.3%；=0.004），而总体术后胰瘘（POPF）与血糖失调的相关性低于血糖正常者（4.7%对19.4%；=0.02）。
与PDAC不同，在其他胰腺/壶腹周围肿瘤中很少观察到NOD。具有临床意义的是，超过三分之一的PDAC患者在术前评估时才被诊断出NOD。术前血糖失调与胰十二指肠切除术中DGE发生率增加及POPF发生率降低相关。
