J Gastric Cancer.  2017 Dec;17(4):283-294. 10.5230/jgc.2017.17.e34.

Long-term Follow-up for Type 2 Diabetes Mellitus after Gastrectomy in Non-morbidly Obese Patients with Gastric Cancer: the Legitimacy of Onco-metabolic Surgery

• Lee TH
• Lee CM
• Park S
• Jung DH
• Jang YJ
• Kim JH
• Park SH
• Mok YJ

• KMID: 2398795
• DOI: http://doi.org/10.5230/jgc.2017.17.e34

Abstract

PURPOSE
This study primarily aimed to investigate the short- and long-term remission rates of type 2 diabetes (T2D) in patients who underwent surgical treatment for gastric cancer, especially patients who were non-obese, and secondarily to determine the potential factors associated with remission.
MATERIALS AND METHODS
We retrospectively reviewed the clinical records of patients with T2D who underwent radical gastrectomy for gastric cancer, from January 2008 to December 2012.
RESULTS
T2D improved in 39 out of 70 (55.7%) patients at the postoperative 2-year follow-up and 21 of 42 (50.0%) at the 5-year follow-up. In the 2-year data analysis, preoperative body mass index (BMI) (P=0.043), glycated hemoglobin (A1C) level (P=0.039), number of anti-diabetic medications at baseline (P=0.040), reconstruction method (statistical difference was noted between Roux-en-Y reconstruction and Billroth I; P=0.035) were significantly related to the improvement in glycemic control. Unlike the results at 2 years, the 5-year data analysis revealed that only preoperative BMI (P=0.043) and A1C level (P=0.039) were statistically significant for the improvement in glycemic control; however, the reconstruction method was not.
CONCLUSIONS
All types of gastric cancer surgery can be effective in short- and long-term T2D control in non-obese patients. In addition, unless long-limb bypass is considered in gastric cancer surgery, the long-term glycemic control is not expected to be different between the reconstruction methods.

Keyword

Type 2 diabetes mellitus; Stomach neoplasms; Surgery; Reconstruction method; Glycemic index; Control

MeSH Terms

Body Mass Index
Diabetes Mellitus, Type 2*
Follow-Up Studies*
Gastrectomy*
Gastroenterostomy
Glycemic Index
Hemoglobin A, Glycosylated
Humans
Illegitimacy*
Methods
Retrospective Studies
Statistics as Topic
Stomach Neoplasms*

Figure

• 

  Fig. 1 Flow diagram of patients in the study. IC = improved control; NC = not improved control.

• 

  Fig. 2 Short- and long-term diabetes remission and relapse rate. Short- and long-term follow-up data showed improved glycemic control in 55.7% and 50.1% of patients. In the long-term, 50% of patients underwent glycemic control that was unchanged or worse compared with the baseline.

• 

  Fig. 3 Impact of operation methods on diabetes improvement at postoperative 2 and 5 years. During the 2-year follow-up, patients who underwent RYTG had significantly higher diabetes improvement rate compared with those who underwent Billroth I (P=0.035).However, the difference in diabetes improvement rate between RYTG and Billroth Iat 5-year follow-up was insignificant. RYTG =total gastrectomy with Roux-en-Y reconstruction.

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