title: Diabetes mellitus does not impact on clinically relevant pancreatic fistula after partial pancreatic resection for ductal adenocarcinoma.
abstract: BACKGROUND
  The prevalence of diabetes mellitus (DM) in patients with pancreatic ductal adenocarcinoma (PDAC) ranges from 20 to 80%. In patients undergoing resection, it is unclear whether DM impacts on clinically relevant pancreatic fistula (CR-PF).
  
  
  METHODS
  To address this issue, data from 602 consecutive partial pancreatic resections were analyzed using univariate and multivariate models.
  
  
  RESULTS
  There were 120 patients with DM; 84 had longstanding DM and 36 a new-onset DM. The incidence of CR-PF was greater among nondiabetics (11.8% vs 5.0%; P = .043), who were also more likely to have a soft pancreatic texture (79.5% vs 46.0%; P = .001) or combined presence of soft texture and small pancreatic duct (high-risk pancreas; P = .001). All these variables did not differ when stratifying by DM type. Univariate analysis showed that gender (P = .005), body mass index (P = .05), DM (P = .043), pancreatic texture (P = .001), pancreatic duct size (P = .012), and the combined presence of soft parenchyma and small duct (P = .001) were associated with CR-PF. On multivariate analysis, DM resulted to be a negative predictor of CR-PF (odds ratio [OR], 0.53; P = .047). Additional variables associated with an increased probability of CR-PF formation were male gender (OR, 3.48; P = .002), soft pancreatic texture (OR, 2.19), pancreatic duct size <3 mm (OR, 1.79), and the combined presence of soft pancreas and small duct (OR, 2.24).
  
  
  CONCLUSIONS
  DM is not a risk factor for CR-PF after resection of PDAC. The decreased incidence of CR-PF in diabetics is likely to be a consequence of a decreased frequency of high-risk features of the pancreatic gland (soft texture and/or small duct).
authors.affiliation: Department of Surgery, Unit of General Surgery B, Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Francesca
authors.initials: F
authors.lastname: Mazzarella
authors.forename: Anna
authors.initials: A
authors.lastname: Malpaga
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome