BACKGROUND: Associations between diabetes mellitus (DM) and pancreatic ductal adenocarcinoma (PDAC) are well established; however, the impact of DM on perioperative morbidity and mortality after PDAC resection is unclear. STUDY DESIGN: A prospectively maintained database review identified all patients undergoing PDAC resection between January 1, 2000, and December 31, 2008. Diagnosis of DM was established by history and biochemical profile. Records were reviewed for comorbidities, operative variables, and histologic parameters. Postoperative morbidity and mortality were assessed for diabetic and nondiabetic patients using standardized definitions. RESULTS: Of 251 PDAC cases, 116 (46%) patients had preoperative DM. Pancreaticoduodenectomy was performed in 220 (87.6%), left pancreatectomy in 29 (11.6%), and total pancreatectomy in 2 (0.8%). The major complication rate was 25.5%, with 60-day mortality of 3.6%. Delayed gastric emptying (DGE) occurred in 40.1% of patients. Pancreatic fistulas developed in 17 (6.8%) patients; 11 of them were clinically significant (grades B/C). DM patients had a higher likelihood of developing fistulas (DM 10.3%, non-DM 3.7%, p = 0.04). When controlled for age, comorbidities, body mass index, preoperative albumin level, operation type, operative time, and pancreatic quality, DM maintained an independent association with fistula formation (odds ratio 4.3, 95% CI 1.18 to 15.8, p = 0.027). Acute kidney injury was more frequent in the DM group (DM 23.3%, non-DM 12.6%, p = 0.03). DM and non-DM patients had similar frequency of DGE, wound infections, intra-abdominal abscesses, and cardiovascular and pulmonary complications, as well as length of stay and mortality. CONCLUSIONS: Comorbid DM does not influence perioperative outcomes dramatically after pancreatectomy for ductal adenocarcinoma. The role of PDAC-associated DM as a risk factor for postresection pancreatic fistula should be further explored. Evaluation of glycemic control and outcomes after PDAC resection may be useful. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
BACKGROUND: Associations between diabetes mellitus (DM) and pancreatic ductal adenocarcinoma (PDAC) are well established; however, the impact of DM on perioperative morbidity and mortality after PDAC resection is unclear. STUDY DESIGN: A prospectively maintained database review identified all patients undergoing PDAC resection between January 1, 2000, and December 31, 2008. Diagnosis of DM was established by history and biochemical profile. Records were reviewed for comorbidities, operative variables, and histologic parameters. Postoperative morbidity and mortality were assessed for diabetic and nondiabeticpatients using standardized definitions. RESULTS: Of 251 PDAC cases, 116 (46%) patients had preoperative DM. Pancreaticoduodenectomy was performed in 220 (87.6%), left pancreatectomy in 29 (11.6%), and total pancreatectomy in 2 (0.8%). The major complication rate was 25.5%, with 60-day mortality of 3.6%. Delayed gastric emptying (DGE) occurred in 40.1% of patients. Pancreatic fistulas developed in 17 (6.8%) patients; 11 of them were clinically significant (grades B/C). DMpatients had a higher likelihood of developing fistulas (DM 10.3%, non-DM 3.7%, p = 0.04). When controlled for age, comorbidities, body mass index, preoperative albumin level, operation type, operative time, and pancreatic quality, DM maintained an independent association with fistula formation (odds ratio 4.3, 95% CI 1.18 to 15.8, p = 0.027). Acute kidney injury was more frequent in the DM group (DM 23.3%, non-DM 12.6%, p = 0.03). DM and non-DMpatients had similar frequency of DGE, wound infections, intra-abdominal abscesses, and cardiovascular and pulmonary complications, as well as length of stay and mortality. CONCLUSIONS: Comorbid DM does not influence perioperative outcomes dramatically after pancreatectomy for ductal adenocarcinoma. The role of PDAC-associated DM as a risk factor for postresection pancreatic fistula should be further explored. Evaluation of glycemic control and outcomes after PDAC resection may be useful. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Authors: Robert M Cannon; Ryan LeGrand; Ryaz B Chagpar; Syed A Ahmad; Rebecca McClaine; Hong Jin Kim; Christopher Rupp; Cliff S Cho; Adam Brinkman; Sharon Weber; Emily R Winslow; David A Kooby; Carrie K Chu; Charles A Staley; Ian Glenn; William G Hawkins; Alexander A Parikh; Nipun B Merchant; Kelly M McMasters; Robert C G Martin; Glenda G Callender; Charles R Scoggins Journal: HPB (Oxford) Date: 2012-01-19 Impact factor: 3.647
Authors: Chen Yuan; Douglas A Rubinson; Zhi Rong Qian; Chen Wu; Peter Kraft; Ying Bao; Shuji Ogino; Kimmie Ng; Thomas E Clancy; Richard S Swanson; Megan J Gorman; Lauren K Brais; Tingting Li; Meir J Stampfer; Frank B Hu; Edward L Giovannucci; Matthew H Kulke; Charles S Fuchs; Brian M Wolpin Journal: J Clin Oncol Date: 2014-11-17 Impact factor: 44.544
Authors: Donghui Li; Yixiang Mao; Ping Chang; Chang Liu; Manal M Hassan; Saiching J Yeung; James L Abbruzzese Journal: Am J Cancer Res Date: 2015-09-15 Impact factor: 6.166
Authors: Adedayo A Onitilo; Jessica M Engel; Ingrid Glurich; Rachel V Stankowski; Gail M Williams; Suhail A Doi Journal: Cancer Causes Control Date: 2012-05-03 Impact factor: 2.506
Authors: Abhishek D Parmar; Kristin M Sheffield; Gabriela M Vargas; Henry A Pitt; E Molly Kilbane; Bruce L Hall; Taylor S Riall Journal: HPB (Oxford) Date: 2013-07-22 Impact factor: 3.647
Authors: Pietro Addeo; Jean Robert Delpero; Francois Paye; Elie Oussoultzoglou; Pascal R Fuchshuber; Alain Sauvanet; Antonio Sa Cunha; Yves Patrice Le Treut; Mustapha Adham; Jean-Yves Mabrut; Laurence Chiche; Philippe Bachellier Journal: HPB (Oxford) Date: 2013-03-06 Impact factor: 3.647