Gkiafi Z, Rozani S. New-onset diabetes mellitus after distal pancreatectomy: Incidence, predictors and clinical impact. World J Gastrointest Surg 2026; 18(6): 119845 [DOI: 10.4240/wjgs.119845]
Corresponding Author of This Article
Sofia Rozani, MD, PhD, Academic Fellow, Research Fellow, Department of Surgery II, Aretaieio University Hospital, National and Kapodistrian University of Athens, Vasileos Sofias Street 76, Athens 11528, Attikí, Greece. sofrozan@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2026; 18(6): 119845 Published online Jun 27, 2026. doi: 10.4240/wjgs.119845
New-onset diabetes mellitus after distal pancreatectomy: Incidence, predictors and clinical impact
Zoi Gkiafi, Sofia Rozani
Zoi Gkiafi, Department of Surgery I, Laiko University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Sofia Rozani, Department of Surgery II, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens 11528, Attikí, Greece
Author contributions: Gkiafi Z and Rozani S contributed to data extraction, validation, visualization and writing process at every part of this manuscript.
AI contribution statement: I use Grammarly for language polishing.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Sofia Rozani, MD, PhD, Academic Fellow, Research Fellow, Department of Surgery II, Aretaieio University Hospital, National and Kapodistrian University of Athens, Vasileos Sofias Street 76, Athens 11528, Attikí, Greece. sofrozan@gmail.com
Received: February 7, 2026 Revised: February 25, 2026 Accepted: March 18, 2026 Published online: June 27, 2026 Processing time: 133 Days and 2.3 Hours
Abstract
New-onset diabetes mellitus (NODM) represents a significant postoperative concern following distal pancreatectomy, arising from loss of functional β-cell mass and potential alterations in remnant pancreatic perfusion. With increasing use of distal pancreatectomy for benign and malignant conditions, recognition of its metabolic consequences has become critical in long-term patient management. This review examines current evidence on the incidence, determinants, and clinical relevance of NODM after distal pancreatectomy. Published studies demonstrate a broad range of incidence rates, reflecting variability in surgical techniques, underlying disease processes, and diagnostic criteria for postoperative diabetes. Factors such as preoperative glucose intolerance, pancreatic steatosis, patient age, and the volume of preserved pancreatic tissue appear to play important roles in determining postoperative endocrine function. Additionally, technical considerations-including splenic preservation and maintenance of splenic vessel integrity, may influence the risk of NODM. Clinically, the development of NODM is associated with increased healthcare utilization, lifestyle adjustments, and potential long-term cardiovascular and metabolic complications. This review underscores the importance of early detection, risk stratification, and evidence-based follow-up strategies, while highlighting areas requiring further research to better understand and mitigate NODM after distal pancreatectomy.
Core Tip: New-onset diabetes mellitus is a frequent and clinically important consequence of distal pancreatectomy, driven by loss of β-cell mass and potential impairment of pancreatic remnant perfusion. Its incidence varies widely due to differences in surgical technique, underlying pathology, and patient metabolic status. Key determinants include preoperative glucose intolerance, pancreatic steatosis, patient age, and the volume and vascularization of the remnant gland. Recognizing these risk factors enables improved patient selection, early detection, and tailored follow-up strategies. This review highlights emerging evidence on modifiable operative considerations and underscores the need for targeted research to reduce new-onset diabetes mellitus risk.
