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KMID : 0371320120820060347
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Journal of the Korean Surgical Society
2012 Volume.82 No. 6 p.347 ~ p.355
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Influence of gastrectomy for stomach cancer on type 2 diabetes mellitus for patients with a body mass index less than 30 kg/m2
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Kang Kyu-Chul
Shin Seok-Hwan
Lee Yeon-Ji
Heo Yoon-Seok
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Abstract
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Purpose: The impressive effect of LRYGBP on mildly obese patients (30 kg/m2 < BMI < 35 kg/m2) with T2DM raises the argument for lowering the threshold for surgical intervention to non-obesity (BMI < 30 kg/m2). The goal of this study was to evaluate the effect of gastrectomy on non-obese patients with T2DM and what preoperative clinical factors are associated with postoperative long term improvement.
Methods: In this retrospective review, we analyzed the change in diabetic status in 75 patients with gastric cancer undergoing three different gastrectomies in a single institution from June 1996 to September 2009. Pre- and postoperative fasting blood glucose, serum hemoglobin A1c and diabetic medication requirements were compared. The demographic data and other biochemical markers were also collected.
Results: At an average follow-up of 35.0 ± 25.9 months, we collected the data of 75 patients and evaluated the change of diabetes status. There was no resolution of diabetes in Billroth-I (B-I) group, and 45.2% of patients improved whereas the resolution rate of Billroth-II (B-II) and RY group was 22.2% and 23.5% and 85.2% and 88.2%, respectively. The improvement rate of diabetes mellitus (DM) status was 7.46 times higher in B-II than in B-I patients. The method of reconstruction is the most powerful factor and severity and duration of diabetes showed significant clinical factors for the improvement of the disease after surgery.
Conclusion: According to these results, foregut-bypass procedure may improve the type 2 DM better than can be explained by the effect of weight loss only. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years.
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KEYWORD
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Type 2 diabetes mellitus, Gastrectomy, Gastric bypass, Low BMI, Body mass index
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