Diabetes Metab J. 2023;47(5):703-714.

Glucose Regulation after Partial Pancreatectomy: A Comparison of Pancreaticoduodenectomy and Distal Pancreatectomy in the Short and Long Term.

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제1저자 이준서, 손민지 · 교신저자 임수, 윤유석

PMID 37349082 PMC10555545 DOI 10.4093/dmj.2022.0205 IF 8.2 내분비대사내과

소속 (2)

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Abstract

BACKGRUOUND Long term quality of life is becoming increasingly crucial as survival following partial pancreatectomy rises. The purpose of this study was to investigate the difference in glucose dysregulation after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP).

METHODS In this prospective observational study from 2015 to 2018, 224 patients who underwent partial pancreatectomy were selected: 152 (67.9%) received PD and 72 (32.1%) received DP. Comprehensive assessment for glucose regulation, including a 75 g oral glucose tolerance test was conducted preoperatively, and 1, 12, and 52 weeks after surgery. Patients were further monitored up to 3 years to investigate development of new-onset diabetes mellitus (NODM) in patients without diabetes mellitus (DM) at baseline or worsening of glucose regulation (≥1% increase in glycosylated hemoglobin [HbA1c]) in those with preexisting DM.

RESULTS The disposition index, an integrated measure of β-cell function, decreased 1 week after surgery in both groups, but it increased more than baseline level in the PD group while its decreased level was maintained in the DP group, resulting in a between-group difference at the 1-year examination (P<0.001). During follow-up, the DP group showed higher incidence of NODM and worsening of glucose regulation than the PD group with hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.49 to 12.3) and HR 2.15 (95% CI, 1.09 to 4.24), respectively, in the multivariate analysis including dynamic glycemic excursion profile. In the DP procedure, distal DP and spleen preservation were associated with better glucose regulation. DP had a stronger association with glucose dysregulation than PD.

CONCLUSION Proactive surveillance of glucose dysregulation is advised, particularly for patients who receive DP.

Keywords

Diabetes mellitusPancreatectomyPancreaticoduodenectomyQuality of life

Figures

**Fig. 1.** Changes in glucose metabolism parameters at preoperative, postoperative 1, 12, and 52 weeks in patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP). AUC_Glucose, area under the curve of glucose; AUC_Insulin, area under the curve of insulin; HOMA-β, homeostasis model assessment of β-cell function. ^aP<0.05 between PD and DP groups by paired Student’s t-test or Wilcoxon’s signed-rank test according to the distribution of data, ^bP<0.05 vs. before surgery in the PD group, ^cP<0.05 vs. before surgery in the DP group by Student’s t-test or Wilcoxon’s rank-sum test as above.

**Fig. 2.** Kaplan-Meier estimates of event probability of new-onset diabetes mellitus (NODM) and worsening of DM after pancreatoduodenectomy (PD) or distal pancreatectomy (DP) in 224 patients. The log-rank test revealed significant differences between the PD and DP groups in (A) NODM in nondiabetic patients (n=150), (B) worsening of diabetes mellitus (DM) defined as an increase of glycosylated hemoglobin ≥1% in patients with DM (n=74), and (C) worsening of glucose regulation defined as including both (A) and (B) events in all patients (n=224) (all P<0.05).

그림 출처: PubMed Central 공개 논문 (PMC10555545)

Conflict of interest statement

CONFLICTS OF INTEREST . No potential conflict of interest relevant to this article was reported.

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