Beger HG, et al. - The frequency and severity of new onset of diabetes mellitus (NODM) and pancreatic exocrine insufficiency (PEI) after pancreaticoduodenectomy (PD) for benign and malignant tumors were assessed. Observations revealed a significant increase of NODM after PD for benign and malignant tumors and a significant decrease of exocrine functions. These contributed to a rational weighing of metabolic long-term risks following PD.

Methods

• Researchers searched Medline/PubMed, Embase, and Cochrane Library for articles reporting results of measuring endocrine and exocrine pancreatic functions after PD.
• By means of the Newcastle-Ottawa scale and Moga-Score, they assessed the methodological quality of 19 studies.
• They calculated the mean weighted overall percentages of NODM and PEI after PD with a 95% confidence interval (CI).

Results

• Data valid-for-efficacy-analysis were based on 845 patients measuring pancreatic endocrine and on 964 patients determining exocrine functions after PD among 1295 patients.
• Researchers noted that the cumulative incidence of NODM was 40 of 275 patients (14.5%; 95% CI: 10.3–18.7) in the benign tumor group, 25 of 161 (15.5%; 95% CI: 9.9–21.2) in the malignant tumor group, and 91 of 409 patients (22.2%; 95% CI: 18.2–26.3) in the benign and malignant tumor group.
• Significant differences between the groups (benign vs benign and malignant P < 0.0121; malignant vs benign and malignant P < 0.0017) were observed when compared in terms of frequency of NODM after PD.
• They observed exocrine pancreatic insufficiency in the benign tumor group in 76 of 301 patients (25.2%; 95% CI: 20.3–30.7) and in the malignant tumor group in 80 of 163 patients (49.1%, 95% CI: 41.4–56.8) (P < 0.0001).