Preoperative Predictors of New-Onset Diabetes Mellitus Following Distal Pancreatectomy for Non-functioning Pancreatic Neuroendocrine Tumours

Anna Battistella; Francesco Prato; Valentina Andreasi; Raffaella Rella; Edoardo Guccinelli; Stefano Crippa; Nicolo Pecorelli; Diego Palumbo; Massimo Falconi; Stefano Partelli

doi:10.1530/endoabs.116.C50

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Endocrine Abstracts (2025) 116 C50 | DOI: 10.1530/endoabs.116.C50

NANETS2025 18th Annual Multidisciplinary NET Medical Symposium NANETS 2025 Clinical – Surgery/Applied Pathology (16 abstracts)

Preoperative Predictors of New-Onset Diabetes Mellitus Following Distal Pancreatectomy for Non-functioning Pancreatic Neuroendocrine Tumours

Anna Battistella ^1,2 , Francesco Prato ^2,3 , Valentina Andreasi ^1,2 , Raffaella Rella ² , Edoardo Guccinelli ^2,3 , Stefano Crippa ^1,2 , Nicolò Pecorelli ^1,2 , Diego Palumbo ^2,3 , Massimo Falconi ^1,2 & Stefano Partelli ^1,2

Author affiliations

¹Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; ²Vita-Salute San Raffaele University, Milan, Italy; ³Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

Background: Non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) are typically indolent neoplasms with a rising incidence. Distal pancreatectomy (DP) remains the standard treatment for localized tumours in the pancreatic body/tail. Given the favorable long-term prognosis, accurate assessment of postoperative morbidity, particularly postoperative new-onset diabetes mellitus (PONO-DM), is critical. Aims of the study were to identify preoperative predictors of PONO-DM in patients undergoing DP for NF-PanNETs and to develop a predictive model for individualized risk assessment.

Methods: All consecutive patients who underwent curative DP for localized NF-PanNETs at San Raffaele Hospital (Milan, Italy) between 2015 and 2022 were included. Exclusion criteria included pre-existing diabetes and follow-up < 24 months. Clinical and radiological data, including body composition and pancreatic measurements, were evaluated.

Results: A total of 65 patients were included. After a median follow-up of 58 months, 27/65 patients (41%) developed PONO-DM. PONO-DM was significantly associated with elevated BMI (P = 0.016), pancreatic atrophy (P = 0.044), increased total (P = 0.014) and visceral fat area (P = 0.021), and a greater percentage of resected distal pancreatic parenchyma (HPP, P = 0.046). On Cox regression, higher BMI (HR 1.187; P = 0.001), elevated HbA1c (HR 1.169; P = 0.001), and greater proportion of distal HPP (HR 1.030; P = 0.018) were identified as significant risk factors of PONO-DM. A nomogram and online risk calculator (https://net-distal-pancreatectomy.shinyapps.io/postoperative-diabetes-risk-calculator/) were developed to predict individual risk at 1, 3, and 5 years after surgery, with good discriminatory performance (AUC 0.766; P < 0.001).

Conclusions: PONO-DM occurred in 41% of patients undergoing DP for NF-PanNETs. Elevated BMI, HbA1c and percentage of resected distal HPP emerged as significant risk factors of PONO-DM. The developed nomogram and web-based calculator may support preoperative counseling and guide tailored prehabilitation or parenchyma-sparing strategies in high-risk patients.

Abstract ID #33477