title: The impact of perioperative blood glucose levels on pancreatic cancer prognosis and surgical outcomes: an evidence-based review.
abstract: Although diabetes mellitus (DM) and pancreatic cancer (PC) are intricately linked, a comprehensive review addressing the impact of DM on PC prognosis and surgical outcomes is lacking. PubMed search was performed (1980-2012) using keywords "pancreatic cancer", "diabetes mellitus", "glucose intolerance", "pancreatic resection", "prognosis", and "post-operative outcomes". The search results were analyzed to determine the strength of association between DM and PC and to assess the impact of DM on PC prognosis and postoperative outcomes. Thirty-one studies involving 38,777 patients were identified. Patients with non-insulin-dependent DM have 1.5-2 fold increased relative risk of developing PC. Non-insulin-dependent DM is identified in 25.7% of patients with PC compared to 10.4% age-matched controls (95% confidence interval, 1.5-4.7; P < 0.0001). Patients with PC are more likely to have a diagnosis of new-onset DM than age-matched controls (14.7% vs 2.7%; P < 0.0001). Patients with PC with DM have a significantly lower overall survival than those without DM (14.4 vs 21.7 months; P < 0.001). The presence of DM significantly increases overall postoperative complication rates (45.6% vs 35.6%; P < 0.008). Patients with new-onset non-insulin-dependent DM are at a higher risk of developing PC and have a worse long-term survival and a higher rate of postoperative complications.
authors.affiliation: From the *Department of Medicine, Stony Brook University Hospital, New York, NY; †School of Medicine, Saint George's University, West Indies, Grenada; ‡Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ; §Department of Surgery, Maimonides Medical Center, Brooklyn, NY; and ∥Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ.
authors.forename: Siddharth R
authors.initials: SR
authors.lastname: Raghavan
authors.forename: Umashankar K
authors.initials: UK
authors.lastname: Ballehaninna
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Chamberlain
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D019317:Evidence-Based Medicine; D006801:Humans; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059035:Perioperative Period; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose