J Korean Surg Soc.  2013 Feb;84(2):88-93. 10.4174/jkss.2013.84.2.88.

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

• Kim WS
• Kim JW
• Ahn CW
• Choi SH

• KMID: 2144995
• DOI: http://doi.org/10.4174/jkss.2013.84.2.88

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.

Keyword

Type 2 diabetes mellitus; Roux-en-Y anastomosis; Gastrectomy; Stomach neoplasms

MeSH Terms

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
Hemoglobins

Figure

• 

  Fig. 1 Long limb Roux-en Y anastomosis. After gastrectomy, the gastrointestinal tract was reconstructed by Roux-en Y gastrojejunostomy (A) or esophagojejunostomy (B). The biliopancreatic and Roux limb were 100 to 120 cm long each.

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