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

Abstract

PurposeThis 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 MethodsWe retrospectively reviewed the clinical records of patients with T2D who underwent radical gastrectomy for gastric cancer, from January 2008 to December 2012.ResultsT2D 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.ConclusionsAll 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.

<p>Onco-Metabolic Surgery: A Combined Approach to Gastric Cancer and Hypertension</p>

“…17,18 Weight loss was obtained after bariatric surgery and was a parameter for the remission of hypertension in previous studies. 24 However, in this study, weight loss seemed to be a negative parameter for the remission of hypertension. Consistent with a previous report, lifestyle modifications, such as sodium absorption dysfunction, may play an important role beyond weight loss.…”

Predictors of Remission and Relapse of Diabetes after Conventional Gastrectomy for Gastric Cancer: Nationwide Population-Based Cohort Study

“…A substantial number of diabetic patients who have undergone gastric cancer surgery experience postoperative diabetes remission, which is induced by postoperative weight change and the metabolic effects of surgical procedures. [9][10][11][12] Diabetes remission, defined as achieving normoglycemia without antidiabetic medication after gastric cancer surgery, has been reported in 30%-50% of patients during short-term follow-up. 9,11,12 However, various patient characteristics (such as diabetes severity, weight status, or surgical methods for cancer treatments) influence the rates of diabetes remission, 11,12 and few studies have investigated the long-term durability of diabetes remission.…”

“…Therefore, prediction of the course of diabetes after gastric cancer surgery is required for optimal postoperative diabetes management. We have previously reported a statistical model for predicting 5-year diabetes improvement in a single institution 11 ; to our knowledge, no other report of long-term follow-up study is available to date. To obtain stronger evidence of outcomes, we performed a nationwide, population-based cohort study, which followed diabetes remission and relapse status for 9 years postoperatively.…”

Beneficial effects of proximal intestinal bypass reconstruction on glucose metabolism in a type 2 diabetes animal model: a possible reconstruction strategy for diabetic gastric cancer patients

“…Interestingly, each gastrojejunostomy and conventional Roux-en-Y reconstruction could provide a similar beneficial effect on GT, whereas the gastroduodenostomy did not [ 4 7 28 ]. On the other hand, Lee et al [ 29 ] reported that long-limb bypass is essential for improving long-term glycemic control. A multicenter study also demonstrated the favorable glycemic control after the long-limb (>80 cm of each alimentary and biliopancreatic limb) Roux-en-Y bypass reconstruction over conventional loop gastrojejunostomy after gastrectomy despite no difference in body mass index reduction [ 5 ].…”