Five-year recurrence/survival after pancreatoduodenectomy for pancreatic adenocarcinoma: does pre-existing diabetes matter? Results from the Recurrence After Whipple's (RAW) study

Objectives Diabetes mellitus (DM) has a complex relationship with pancreatic cancer. This study examines the impact of preoperative DM, both recent-onset and pre-existing, on long-term outcomes following pancreatoduodenectomy (PD for pancreatic ductal adenocarcinoma (PDAC). Methods Data were extracted from the Recurrence After Whipple's (RAW) study, a multi-centre cohort of PD performed for pancreatic head malignancy (2012-2015). Recurrence and five-year survival rates of patients with DM were compared to those without. A subgroup analysis was also performed to compare patients with recent-onset DM (less than one year) to patients with established DM. Results Out of 758 patients that were included, 187 (24.7%) had DM, of whom, 47 of the 187 (25.1%) had recent-onset DM. There was no difference in the rate of postoperative pancreatic fistula (DM: 5.9% vs no DM 9.8%; p=0.11), five-year survival (DM: 24.1% vs no DM: 22.9%; p=0.77) or five-year recurrence (DM: 71.7% vs no DM: 67.4%; p=0.32). There was also no difference between patients with recent-onset DM and patients with established DM in postoperative outcomes, recurrence, or survival. Conclusions We found no difference in five-year recurrence and survival between diabetic patients and those without diabetes. Patients with pre-existing DM should be evaluated for PD on a comparable basis to non-diabetic patients.