Resolution of type 2 diabetes after gastrectomy for gastric cancer with long limb Roux-en Y reconstruction: a prospective pilot study.
10.4174/jkss.2013.84.2.88
- Author:
Whan Sik KIM
1
;
Jong Won KIM
;
Chul Woo AHN
;
Seung Ho CHOI
Author Information
1. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. choish@yuhs.ac
- Publication Type:Original Article
- Keywords:
Type 2 diabetes mellitus;
Roux-en-Y anastomosis;
Gastrectomy;
Stomach neoplasms
- MeSH:
Anastomosis, Roux-en-Y;
Anemia;
Body Mass Index;
Diabetes Mellitus, Type 2;
Extremities;
Gastrectomy;
Gastric Bypass;
Gastrointestinal Tract;
Hemoglobins;
Humans;
Malnutrition;
Pilot Projects;
Prospective Studies;
Recurrence;
Stomach Neoplasms
- From:Journal of the Korean Surgical Society
2013;84(2):88-93
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: It is unclear whether metabolic surgery is effective in non obese type 2 diabetes mellitus (T2DM) and the result after gastrectomy and conventional reconstruction for gastric cancer with non obese T2DM are not satisfactory for improvement of T2DM. Prospective single-arm pilot study with long limb Roux-en Y reconstruction after gastrectomy was evaluated on its safety and efficacy as a potential cure for T2DM in patients with non obese gastric cancer. METHODS: Fifteen patients with non obese T2DM and gastric cancer were enrolled. After gastrectomy, the gastrointestinal tract was reconstructed by Roux-en Y gastrojejunostomy or esophagojejunostomy. The biliopancreatic and Roux limb were 100 to 120 cm long each. RESULTS: There was no surgery-related mortality, but four cases experienced complications (26.7%). Before surgery, the mean body mass index was 25.2 +/- 3.4 kg/m2 and mean glycated hemoglobin (HbA1c) was 7.7 +/- 1.4% with antidiabetic medications. The mean BMI decreased to 21.7 +/- 3.1 kg/m2 (P < 0.05) and the mean HbA1c decreased to 6.3 +/- 0.8% (P < 0.05) 6 months after surgery. At the end of the study (follow-up duration, 12.5 +/- 5.5 months), HbA1c decreased to <6% in 11 patients (78.6%) without any antidiabetic medications. There were no patients who had anemia, and/or malnutrition after surgery except one patient who died due to recurrence four months after surgery. CONCLUSION: Long limb Roux-en Y reconstruction after gastrectomy is feasible and has the potential to cure T2DM in non obese gastric cancer patients. A randomized controlled trial is needed to confirm this result.
