Abstract

Purpose: Bariatric surgery has proven to be effective in weight reduction as well as diabetes resolution. The purpose of this retrospective study was to evaluate the factors related to diabetic remission after radical gastrectomy and to determine the effect of different reconstruction methods on metabolic control in non-obese patients with type 2 diabetes mellitus (T2DM) who underwent surgery for gastric cancer.
Materials and Methods: Patients who underwent radical gastrectomy for histologically proven gastric cancer between January 2005 and December 2012 at Soonchunhyang University Seoul hospital were retrospectively reviewed. Among them, 51 patients diagnosed with T2DM at the time of surgery were enrolled in this study. Pre- and postoperative fasting blood sugar (FBS), serum hemoglobin A1c level, and diabetic medication requirements were obtained and analyzed for determination of the patients’ diabetic status.
Results: During the mean follow-up period of 26±21 months, 12 patients (23.5%) showed diabetic remission, 15 (29.4%) showed improvement, and 24 patients (47.1%) showed the same or worse status of diabetes. Diabetic remission showed significant correlation with the type of reconstruction, duodenal exclusion, duration of diabetes, and preoperative FBS concentration (P=0.038, 0.022, 0.018 and 0.017, respectively). No correlation was observed between surgical extent, BMI change or follow-up period after surgery and postoperative diabetic status. In 37 patients who underwent duodenal bypass, FBS concentration showed a significant decrease, from 137±47 mg/dl to120±28 mg/dl after surgery (P=0.017).
Conclusion: Duodenal exclusion appears to have some influence on diabetic remission beyond weight loss in non-obese gastric cancer patients. Selection of a procedure with duodenal bypass after gastrectomy for gastric cancer patients with T2DM might be reasonable with regard to better glycemic control. (SMN 2013;4:18-23)

• Keywords: Type 2 diabetes mellitus, Gastrectomy, Gastric cancer