Journal Article

A single-center prospective analysis of the impact of glucose metabolism on pancreatic fistula onset after pancreaticoduodenectomy for periampullary tumors

Laterza, Vito, Sionne, Francesco, Brunetti, Michela, Quero, Giuseppe, Giaccari, Andrea, Rosa, Fausto, De Sio, Davide, Biffoni, Beatrice, Menghi, Roberta, Langellotti, Lodovica, Mezza, Teresa, Soldovieri, Laura, Pontecorvi, Alfredo, Tondolo, Vincenzo, Massimiani, Giuseppe, Ciccarelli, Gea, Gasbarrini, Antonio, Alfieri, Sergio, Di Giuseppe, Gianfranco, Nista, Enrico Celestino, Fiorillo, Claudio, Lucinato, Chiara

2024

Overview

Glucose impairment notably affects the postoperative course of gastrointestinal surgeries. However, evidence on its impact on clinically relevant pancreatic fistulas(CR-POPFs) after pancreaticoduodenectomy(PD) is lacking. This study evaluates if and how preoperative glucose metabolism affects the development of CR-POPF after PD. One hundred and ten consecutive PDs were included. Patients underwent preoperative metabolic profiling using the Oral Glucose Tolerance Test(OGTT) and the hyperinsulinemic euglycemic clamp procedure. Accordingly, patients were categorized as normal glucose tolerant (NGT), impaired glucose tolerant (IGT), diabetic (DM), and longstanding-DM. Receiver operating characteristics(ROC) analyses were performed to determine the values of metabolic features in prediction of CR-POPF. The CR-POPF rate was 36.3 ​%(40 patients). NGT patients had a higher CR-POPF rate (51.7 ​%) compared to IGT(45.2 ​%), DM (15.8 ​%), and longstanding-DM (25.8 ​%) (p ​= ​0.03). CR-POPF patients had lower median fasting glucose levels (p ​= ​0.01) and higher c-peptide values at all OGTT time points (p ​< ​0.05). Fasting glucose and c-peptide levels had high diagnostic accuracy for CR-POPF (AUC>0.8) and were independent risk factors for CR-POPF (OR: 24.7[95%CI: 3.7–165.3] for fasting glucose; OR: 19.9[95%CI: 3.2–125.3] for c-peptide). Normoglycemia and normal beta cell function may be risk factors for CR-POPF after PD. Fasting glucose and c-peptide levels effectively predicted CR-POPF development following PD. NCT02175459 [Display omitted] •The impact of glucose metabolism on the post-operative course and clinically relevant pancreatic fistula (CR-POPF) development after pancreaticoduodenectomy (PD) is still a field of investigation.•Patients undergoing PD were prospectively enrolled and underwent a preoperative comprehensive metabolic assessment.•Normoglycemia and normal β-cell function were recognized as risk features for CR-POPF development. fasting glucose and c-peptide levels demonstrated a high accuracy in prediction of CR-POPF.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Ampulla of Vater - surgery / Beta cells / Blood Glucose - analysis / Blood Glucose - metabolism / Body mass index / Common Bile Duct Neoplasms - metabolism / Common Bile Duct Neoplasms - surgery / Diabetes / Diabetes mellitus / Endocrine function / Ethics / Fasting / Female / Fistula / Gastrointestinal surgery / Glucose / Glucose metabolism / Glucose tolerance / Glucose Tolerance Test / Humans / Hyperglycemia / Impact analysis / Insulin / Kidney diseases / Laboratory testing / Male / Metabolism / Middle Aged / Mortality / Pancreas / Pancreatectomy / Pancreatic Fistula - epidemiology / Pancreatic Fistula - etiology / Pancreatic Neoplasms - surgery / Pancreatic surgery / Pancreaticoduodenectomy / Pancreaticoduodenectomy - adverse effects / Patients / Peptides / POPF / Postoperative Complications - diagnosis / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - metabolism / Prospective Studies / Risk Factors