Distal pancreatectomy: incidence of postoperative diabetes.
BACKGROUND
Distal pancreatectomy is an accepted and safe procedure for lesions of the body and tail of the pancreas. Limited resections, including central pancreatectomy, have recently been advocated as possible strategies to preserve pancreatic endocrine function. The true rate of diabetes after distal pancreatectomy is not known, but we hypothesize that the risk is nominal.


METHODS
We reviewed 125 consecutive patients who underwent distal pancreatectomy between January 1, 1992, and March 31, 2006.


RESULTS
Of these 125 patients, 27 (21.6%) had an islet cell tumor, 25 (20%) adenocarcinoma, 24 (18.4%) serous cystic neoplasm, 19 (15.2%) mucinous cystic neoplasm, 11 (8.8%) chronic pancreatitis, and eight (6.4%) intraductal papillary mucinous neoplasm. In addition to the distal pancreatectomy, 105 (84%) of the patients underwent splenectomy and 12 (9.6%) a concomitant liver resection. The median operative time was 232 min and median blood loss 250 cc. Postoperative complications occurred in 44 (35.2%) patients (12% fistula), and there was one death. Fourteen patients had known type 2 diabetes preoperatively.


CONCLUSIONS
With a median follow-up of 21 months, 10 (9%) of previously nondiabetic patients developed new onset diabetes. There was a trend toward increased risk of new onset diabetes among patients with pancreatitis (odds ratio, 2.9). In the absence of pancreatitis, the rate was 7.5%. Length of hospitalization was greater for patients with new onset diabetes (9.4 vs 7.5, P < .05). Neither demographics, diagnosis, nor operative statistics impacted the risk of postoperative diabetes.


CONCLUSIONS
We conclude that the rate of clinically apparent new onset diabetes after distal pancreatectomy is minimal. Alternative pancreatic resections aimed at preserving pancreatic mass are likely to be unwarranted.
Department of Surgery, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, CHS 72-170, Los Angeles, CA 90095-6904, USA.
Jonathan
J
King
Kevork
K
Kazanjian
J
J
Matsumoto
Howard A
HA
Reber
Michael W
MW
Yeh
O Joe
OJ
Hines
Guido
G
Eibl
D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
D001786:Blood Glucose