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

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/m(2) and mean glycated hemoglobin (HbA1c) was 7.7 ± 1.4% with antidiabetic medications. The mean BMI decreased to 21.7 ± 3.1 kg/m(2) (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.

SUBMITTER: Kim WS

PROVIDER: S-EPMC3566474 | biostudies-literature | 2013 Feb

REPOSITORIES: biostudies-literature

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

Kim Whan Sik WS Kim Jong Won JW Ahn Chul Woo CW Choi Seung Ho SH

Journal of the Korean Surgical Society 20130129 2

<h4>Purpose</h4>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.<h4>Methods</h4>Fifteen patient ...[more]

PMID: 23396643

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Project description:BackgroundAltered enteroendocrine hormone responses are widely believed to underlie the beneficial effects of bariatric surgery in type 2 diabetes. While elevated postprandial glucagon-like peptide-1 (GLP-1) is considered one of the mediators, increased postprandial glucagon levels have recently been implicated.ObjectivesWe investigated hormonal responses in lean patients after prophylactic total gastrectomy (PTG), as a model of Roux-en-Y gastric bypass without the confounding effects of obesity or massive weight loss.SettingUniversity hospital, United Kingdom.MethodsTen participants after PTG and 9 healthy volunteers were recruited for oral glucose tolerance tests. Plasma glucose, insulin, GLP-1, peptide YY, glucose-dependent insulinotropic-polypeptide, glucagon, oxyntomodulin, glucagon(1-61), and glicentin levels were assessed using immunoassays and/or mass spectrometry.ResultsPTG participants exhibited accelerated plasma glucose appearance, followed, in 3 of 10 cases, by hypoglycemia (<3 mM glucose). Plasma GLP-1, peptide YY, glucose-dependent insulinotropic-polypeptide, glicentin, and oxyntomodulin responses were elevated, and glucagon appeared to rise in PTG participants when measured with a glucagon-specific enzyme-linked immunosorbent assay. We revisited the specificity of this assay, and demonstrated significant cross-reactivity with glicentin and oxyntomodulin at concentrations observed in PTG plasma. Reassessment of glucagon with the same assay using a modified protocol, and by liquid chromatography-mass spectrometry, demonstrated suppression of glucagon secretion after oral glucose tolerance tests in both PTG and control cohorts.ConclusionsCare should be taken when assessing glucagon levels in the presence of elevated plasma levels of other proglucagon products. Substantial elevation of GLP-1 and insulin responses after PTG likely contribute to the observed hypoglycemia, and mirror similar hormone levels and complications observed in bariatric weight loss patients.

Project description:Among a US cohort followed 5 years after Roux-en-Y gastric bypass or sleeve gastrectomy, cumulative incidence of marriage and separation/divorce were 18% among unmarried (N=614) and 13% among married (N=827) participants, respectively. Preoperative predictors of marriage included younger age, college degree, lower BMI and cohabitating or being separated (versus single).ObjectivesTo describe changes in marital status following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).BackgroundSpousal encouragement and finding a life partner are self-reported motivators for undergoing bariatric surgery.MethodsThis study included 1441 US adults enrolled in a 6-center prospective cohort study who underwent RYGB or SG (2006-2009) and self-reported marital status preoperatively and annually postoperatively for ≤5 years. Time to change in marital status was analyzed with Kaplan-Meier estimates of cumulative incidence and Cox proportional-hazard models.ResultsPreoperative, 57% of participants (79% female, median age 47 years, median body mass index [BMI] 47 kg/m2) were married, 5% cohabitating, 4% separated, 15% divorced, 2% widowed, and 17% always single. The 5-year cumulative incidence of marriage among unmarried participants (N = 614) was 18%. Cohabitating (hazard ratios [HR] = 5.25) or being separated (HR = 3.03) versus always single, younger age (HR = 1.69/10 years), having a college degree versus ≤high school (HR = 2.36), lower BMI (HR = 1.54/10kg/m2), and fewer depressive symptoms (HR = 1.47/10 Beck Depression Inventory points) preoperative independently predicted (P < 0.05) higher chance of marriage. The 5-year cumulative incidence of separation/divorce among married participants (N = 827) was 13%. Female sex (HR = 2.08), younger age (HR = 1.84/10 years), household income <$25,000 versus ≥$100,000 (HR = 2.48), smoking (HR = 1.76), and sexual desire ≥once/week versus never (HR = 2.12) preoperative independently predicted (P ≤ 0.05) separation/divorce.ConclusionsAmong a cohort of US adults, the majority did not change marital status within 5 years following RYGB or SG. Cumulative incidence of marriage and separation/divorce was 18% among unmarried and 13% among married participants, respectively. Several preoperative predictors of marriage and separation/divorce were identified.

Dataset Information

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

Publications

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

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