Resolution of type 2 diabetes after gastrectomy for gastric cancer with long limb Roux-en Y reconstruction: a prospective pilot study

Abstract

PurposeIt 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.MethodsFifteen 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.ResultsThere 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.ConclusionLong 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.

Clinical Course of Diabetes After Gastrectomy According to Type of Reconstruction in Patients with Concurrent Gastric Cancer and Type 2 Diabetes

“…Although both the biliopancreatic limb and Roux limb were shorter, the effect of the surgery on DM was still good. Kim et al [22] designed a gastrectomy procedure involving long-limb Roux-en-Y reconstruction for the treatment of gastric cancer in patients with T2DM. In their procedure, the biliopancreatic and Roux limbs were 100 and 120 cm, respectively, which were much longer than those in our operation.…”

The effect of long Roux-en-Y gastrojejunostomy in gastric cancer patients with type 2 diabetes and body mass index & 35 kg/m2: preliminary results

“…Similarly, Ferzli et al [ 15 ] and Geloneze et al [ 16 ] also concluded that duodenal-jejunal bypass is a safe surgery and a valuable option in the treatment of T2DM. A few studies have reported the efficacy of RY gastric bypass to treat T2DM in patients with a BMI < 35 kg/m 2 with remission rate from 48.1% to 100% [ 17 , 18 , 19 , 20 ]. In Korea, gastric cancer surgery is popular, so we experienced many postgastrectomy diabetic patients of low BMI.…”

“…It is presumed that our study group included patients with a relatively shorter length of the total bypassed jejunum and alimentary limb (RY limb). In fact, in the previous studies on T2DM patients with BMI < 35 kg/m 2 , the total length of the bypassed jejunum was in the range of 200-250 cm and the length of the RY limb was 150 cm [ 17 , 18 , 19 , 20 ]. In contrast, 26 patients (87%) in the present study had a total bypassed jejunum length of <200 cm and 29 patients (96.7%) had an RY limb length of <150 cm.…”

Estado nutricional e metabólico de pacientes gastrectomizados e colectomizados por câncer clinicamente curados com e sem diabetes mellitus: impacto da homeostase glicídica sobre variáveis clínicas e bioquímicas

“…A recomendação para realização da cirurgia bariátrica em diabéticos é ter um Outro estudo realizado recentemente com indivíduos diabéticos submetidos à gastrectomia por câncer, entretanto com a reconstrução feita com alças mais longas, demonstrou resultados animadores com 78,6% apresentando hemoglobina glicada inferior a 6%, sem uso de medicamentos após aproximadamente 12,5 meses, além de melhorar a secreção de insulina (Kim et al, 2013).…”