title: Resolution of type 2 diabetes after gastrectomy for gastric cancer with long limb Roux-en Y reconstruction: a prospective pilot study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors: Whan Sik
authors: WS
authors: Kim
authors: Jong Won
authors: JW
authors: Kim
authors: Chul Woo
authors: CW
authors: Ahn
authors: Seung Ho
authors: SH
authors: Choi
keywords: Gastrectomy; Roux-en-Y anastomosis; Stomach neoplasms; Type 2 diabetes mellitus
references: Obes Surg. 2011 Jun;21(6):797-804
references: 21479976
references: Lancet. 2011 Jul 2;378(9785):31-40
references: 21705069
references: Gastric Cancer. 2011 Jun;14(2):113-23
references: 21573742
references: Ann N Y Acad Sci. 2010 Nov;1212:E37-45
references: 21732953
references: Ann Surg. 2008 Jun;247(6):968-75
references: 18520224
references: Int J Epidemiol. 2002 Feb;31(1):175-80
references: 11914317
references: Diabetes Care. 1999 May;22(5):818-22
references: 10332688
references: Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2
references: 7677463
references: J Surg Res. 2010 Nov;164(1):e67-71
references: 20863527
references: Surg Obes Relat Dis. 2007 Mar-Apr;3(2):195-7
references: 17386401
references: J Clin Endocrinol Metab. 2000 Jul;85(7):2402-10
references: 10902785
references: Surg Endosc. 2009 Jun;23(6):1313-20
references: 18830750
references: Surg Obes Relat Dis. 2006 May-Jun;2(3):401-4, discussion 404
references: 16925363
references: Diabetes Care. 2008 Mar;31(3):596-615
references: 18308683
references: World J Gastroenterol. 2012 Jan 7;18(1):49-54
references: 22228970
references: Endocrinology. 2009 Jun;150(6):2518-25
references: 19372197
references: Diabetes Res Clin Pract. 2012 Feb;95(2):179-88
references: 22019271
references: Diabetologia. 2002 Jul;45(Suppl 1):S13-S17
references: 27942779
references: Diabetes Care. 2010 Jul;33(7):e93
references: 20587713
references: Expert Rev Gastroenterol Hepatol. 2010 Apr;4(2):217-23
references: 20350267
references: Lancet. 2006 Nov 11;368(9548):1681-8
references: 17098087
references: Surg Gynecol Obstet. 1955 Feb;100(2):201-4
references: 13238177
references: N Engl J Med. 2004 Dec 23;351(26):2683-93
references: 15616203
references: J Gastrointest Surg. 2008 May;12(5):945-52
references: 17940829
references: Ann Surg. 2006 Nov;244(5):741-9
references: 17060767
references: Acta Med Scand. 1961 Jun;169:743-8
references: 13683582
references: Am J Med. 2009 Mar;122(3):248-256.e5
references: 19272486
references: J Obes. 2011;2011:860169
references: 21461399
references: Obes Surg. 2011 May;21(5):663-7
references: 21336559
references: Diabetes Care. 1998 Dec;21(12):2191-2
references: 9839117