Outcome After Curative Surgery for Gastric Cancer Patients with Type 2 Diabetes

• Published in: World journal of surgery Vol. 38; no. 2; pp. 431 - 438
• Main Authors: Wang, Kuo-Chung, Huang, Kuo-Hung, Lan, Yuan-Tzu, Fang, Wen-Liang, Lo, Su-Shun, Li, Anna Fen-Yau, Wu, Chew-Wun
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2014; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Bariatric Surgery; Cardiac Surgery; Comorbidity; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - surgery; Factor Analysis, Statistical; Fasting Blood Glucose Level; Female; Gastrectomy - methods; Gastric Bypass; Gastric Cancer Patient; General Surgery; Humans; Male; Medicine; Medicine & Public Health; Multivariate Analysis; Retrospective Studies; Roux Limb; Stomach Neoplasms - epidemiology; Stomach Neoplasms - surgery; Surgery; Thoracic Surgery; Total Gastrectomy; Treatment Outcome; Vascular Surgery; Roux Limb; Fasting Blood Glucose Level; Gastric Bypass; Gastric Cancer Patient; Total Gastrectomy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2291-3

Background Bariatric surgery has been adapted to the management of morbid obesity, leading to not only loss of body weight but also improvement of type 2 diabetes mellitus (DM). The goal of our study was to evaluate the effect of gastrectomy in gastric cancer patients with type 2 DM. Methods From 1989 to 2011, a total of 69 gastric cancer patients receiving curative surgery were enrolled in this study. They were diagnosed with type 2 DM preoperatively and all are alive without tumor recurrence. The clinical characteristics were compared between groups with improved or unimproved DM, and groups were also analyzed based on the extent of gastrectomy and different reconstruction methods. Results Of the 69 patients, 58 received subtotal gastrectomy and 11 received total gastrectomy. The frequency of DM improvement was significantly higher after total gastrectomy than subtotal gastrectomy (81.8 vs. 36.2 %; p  = 0.007). Patients with DM duration of less than 5 years tended to experience DM improvement after surgery more frequently than patients with DM duration of more than 5 years ( p  = 0.028). Roux-en-Y esophagojejunostomy (R-Ye) led to a higher rate of DM improvement than did R-Y gastrojejunostomy (R-Yg), especially in patients with DM duration more than 5 years. Among patients receiving duodenal bypass after gastrectomy, R-Ye was associated with a higher frequency of DM improvement than R-Yg and B-II. Conclusions The extent of gastrectomy rather than the reconstruction method played an important role in DM improvement after curative surgery for gastric cancer.