Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance
Objectives: Current evidence regarding metabolic surgery suggests that different types of digestive tract reconstruction can result in differences in postoperative glucose tolerance. This study evaluated the impact of Billroth I (B-I), Billroth II (B-II), and Roux-en-Y (R-Y) procedures on peri-opera...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Fujita Medical Society
2019-02-01
|
Series: | Fujita Medical Journal |
Subjects: | |
Online Access: | https://www.jstage.jst.go.jp/article/fmj/5/1/5_2018-004/_pdf/-char/en |
id |
doaj-b127e97d87f64035b89cec5ddd778001 |
---|---|
record_format |
Article |
spelling |
doaj-b127e97d87f64035b89cec5ddd7780012020-11-25T02:19:08ZengFujita Medical SocietyFujita Medical Journal2189-72472189-72552019-02-01511810.20407/fmj.2018-004Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose toleranceKenichi NakamuraKoichi SudaAtsushi SuzukiMasaya NakauchiSusumu ShibasakiKenji KikuchiTetsuya NakamuraShinichi KadoyaKazuki InabaIchiro UyamaObjectives: Current evidence regarding metabolic surgery suggests that different types of digestive tract reconstruction can result in differences in postoperative glucose tolerance. This study evaluated the impact of Billroth I (B-I), Billroth II (B-II), and Roux-en-Y (R-Y) procedures on peri-operative glucose tolerance in patients with gastric carcinoma who had diabetes mellitus. Methods: A single-institution, retrospective cohort study was conducted using data from patients who underwent totally laparoscopic distal gastrectomy. These patients were grouped according to the type of reconstruction (B-I, B-II, or R-Y). After the operation, we addressed the changes in glucose tolerance—including changes in HbA1c levels, remission of diabetes, and overall effects of the treatment. Results: We studied 57 patients (B-I, n=32; B-II, n=17; R-Y, n=8). B-II and R-Y reconstruction improved HbA1c levels more than B-I. Notably, R-Y improved tolerance the most (B-I vs. B-II, p<0.001; B-I vs. R-Y, p<0.001; B-II vs. R-Y, p<0.001). The type of reconstruction (B-II and R-Y vs. B-I) and a pre-operative HbA1c ≥7% were the two significant independent contributing factors determining postoperative improvement in HbA1c, with odds ratio (OR) 8.437, 95% confidence interval (CI) 1.635–43.527, p=0.011; OR 16.5, 95% CI 3.361–81.011, p=0.001, respectively. Conclusions: Either R-Y or B-II should be considered the primary option for patients with gastric carcinoma and diabetes when glycemic control is insufficient.https://www.jstage.jst.go.jp/article/fmj/5/1/5_2018-004/_pdf/-char/enstomach neoplasmsreconstructive surgical proceduresdiabetes mellitus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kenichi Nakamura Koichi Suda Atsushi Suzuki Masaya Nakauchi Susumu Shibasaki Kenji Kikuchi Tetsuya Nakamura Shinichi Kadoya Kazuki Inaba Ichiro Uyama |
spellingShingle |
Kenichi Nakamura Koichi Suda Atsushi Suzuki Masaya Nakauchi Susumu Shibasaki Kenji Kikuchi Tetsuya Nakamura Shinichi Kadoya Kazuki Inaba Ichiro Uyama Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance Fujita Medical Journal stomach neoplasms reconstructive surgical procedures diabetes mellitus |
author_facet |
Kenichi Nakamura Koichi Suda Atsushi Suzuki Masaya Nakauchi Susumu Shibasaki Kenji Kikuchi Tetsuya Nakamura Shinichi Kadoya Kazuki Inaba Ichiro Uyama |
author_sort |
Kenichi Nakamura |
title |
Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
title_short |
Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
title_full |
Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
title_fullStr |
Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
title_full_unstemmed |
Distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
title_sort |
distal gastrectomy for gastric carcinoma in patients with diabetes mellitus: impact of reconstruction type on glucose tolerance |
publisher |
Fujita Medical Society |
series |
Fujita Medical Journal |
issn |
2189-7247 2189-7255 |
publishDate |
2019-02-01 |
description |
Objectives: Current evidence regarding metabolic surgery suggests that different types of digestive tract reconstruction can result in differences in postoperative glucose tolerance. This study evaluated the impact of Billroth I (B-I), Billroth II (B-II), and Roux-en-Y (R-Y) procedures on peri-operative glucose tolerance in patients with gastric carcinoma who had diabetes mellitus. Methods: A single-institution, retrospective cohort study was conducted using data from patients who underwent totally laparoscopic distal gastrectomy. These patients were grouped according to the type of reconstruction (B-I, B-II, or R-Y). After the operation, we addressed the changes in glucose tolerance—including changes in HbA1c levels, remission of diabetes, and overall effects of the treatment. Results: We studied 57 patients (B-I, n=32; B-II, n=17; R-Y, n=8). B-II and R-Y reconstruction improved HbA1c levels more than B-I. Notably, R-Y improved tolerance the most (B-I vs. B-II, p<0.001; B-I vs. R-Y, p<0.001; B-II vs. R-Y, p<0.001). The type of reconstruction (B-II and R-Y vs. B-I) and a pre-operative HbA1c ≥7% were the two significant independent contributing factors determining postoperative improvement in HbA1c, with odds ratio (OR) 8.437, 95% confidence interval (CI) 1.635–43.527, p=0.011; OR 16.5, 95% CI 3.361–81.011, p=0.001, respectively. Conclusions: Either R-Y or B-II should be considered the primary option for patients with gastric carcinoma and diabetes when glycemic control is insufficient. |
topic |
stomach neoplasms reconstructive surgical procedures diabetes mellitus |
url |
https://www.jstage.jst.go.jp/article/fmj/5/1/5_2018-004/_pdf/-char/en |
work_keys_str_mv |
AT kenichinakamura distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT koichisuda distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT atsushisuzuki distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT masayanakauchi distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT susumushibasaki distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT kenjikikuchi distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT tetsuyanakamura distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT shinichikadoya distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT kazukiinaba distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance AT ichirouyama distalgastrectomyforgastriccarcinomainpatientswithdiabetesmellitusimpactofreconstructiontypeonglucosetolerance |
_version_ |
1724878268294758400 |