Purpose: Total gastrectomy is followed by weight loss in the majority of patients, but the reason for this is not clear. Ghrelin, a novely isolated gastric hormone, exerts orexigenic activity. If a circulating ghrelin participates in the adaptive response to weight loss, the weight loss induced by total gastrectomy may be accompanied by impaired ghrelin secretion.
Methods: The blood was collected from gastric cancer patients who have undergone gastric resection, preoperatively and immediately after resection, on the 1st, 3rd and 7th postoperative day. The correlation of the preoperative plasma ghrelin concentration with gender, age and BMI were analyzed. The concentration changes of plasma ghrelin were observed serially after dividing gastrectomized patients into the subtotal gastrectomy group, the total gastrectomy group, and the proximal gastrectomy group.
Results: Although statistically not significant, the plasma ghrelin concentration was negatively correlated with age and BMI. In the subtotal gastrectomy group, nadir ghrelin was 48.4±23.6% of the preoperative value after gastric resection and then gradually increased to 82.4±19.9% on the 7th postoperative day. In the total gastrectomy group, nadir ghrelin was 36.9±10.4% of the preoperative value after gastric resection and remained 20.9±10.9% on the 7th postoperative day. In the proximal gastrectomy group, nadir ghrelin was 29.4±4.6% after gastric resection, which was followed by a gradual recovery. However, the recovery rate was steadier than compare to the subtotal gastrectomy group, as the concentration was 41.8±23.1% even on 7th postoperative day.
Conclusion: The principal site of the ghrelin synthesis is stomach which contributes 60~70% to the circulating concentration of ghrelin. In the case of subtotal gastrectomy, ghrelin production is compensated by the remnant stomach. For this reason total gastrectomy is associated with suppressed ghrelin levels and it possibly contribute to the weight loss.
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