Pancreatic volumetric assessment as a predictor of new-onset diabetes following distal pancreatectomy

Sachiyo Shirakawa, Ippei Matsumoto, Hirochika Toyama, Makoto Shinzeki, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku, Sachiyo Shirakawa, Ippei Matsumoto, Hirochika Toyama, Makoto Shinzeki, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku

Abstract

Introduction: Pancreatogenic diabetes after pancreatectomy is of growing importance due to the increasing life expectancy of pancreatectomized patients. Although reduction of pancreatic volume is thought to affect glucose metabolism, a consistent relationship has yet to be determined. This study aimed to investigate functional consequences of distal pancreatectomy (DP) in preoperatively non-diabetic patients.

Methods: This study included 61 non-diabetic patients who underwent DP. Clinical data were obtained, and the percent resected volume (PRV) of each pancreas was determined via multi-detector row computed tomography volumetry.

Results: During the follow-up period (median 26 months), 22 patients (36 %) developed new-onset diabetes within a median onset time of 8 months (range 0.5-42 months) postoperatively. The remaining 39 patients also showed impaired glucose metabolism. Multivariate analysis identified preoperative hemoglobin A1c ≥ 5.7 % (odds ratio 15.6, p = 0.001) and PRV > 44 % (odds ratio 11.3, p = 0.004) as independent risk factors for new-onset diabetes.

Conclusions: Key determinants of postoperative glycemic control include preoperative functional reserve of the endocrine pancreas and the volume reduction of pancreatic parenchyma. Our findings enable reliable preoperative evaluation of the risk of postoperative diabetes and appropriate postoperative surveillance, which is helpful for early intervention in high risk patients.

Figures

Fig. 1
Fig. 1
MDCT pancreas volumetry. Outlined areas are the remnant parenchyma (black outline), resected parenchyma (light gray outline), and tumor (dark grey outline), excluding vessels. The dashed line is the pancreatic resection line. To determine percent resected volume, the volume (in milliliters) of the pancreatic parenchyma per slice was calculated as the product of the pancreas area (in square millimeters) times the slice thickness (in millimeters)
Fig. 2
Fig. 2
Changes in parameters before and 3, 6, and 12 months after surgery: a FPG, b HbA1c, c body weight, and d serum albumin. Values from patients who developed new-onset diabetes (solid lines) were compared with non-diabetic patients (dashed lines) using ANOVA, with evaluation of the sphericity assumption by the Mauchly test. Postoperatively, there were significant between-group differences in changes in FPG (p = 0.003) and HbA1c levels (p < 0.001). No significant between-group difference in body weight (p = 0.36) or albumin (p = 0.58) was observed

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