Kim Whan Sik, Kim Jong Won, Ahn Chul Woo, Choi Seung Ho
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Korean Surg Soc. 2013 Feb;84(2):88-93. doi: 10.4174/jkss.2013.84.2.88. Epub 2013 Jan 29.
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.
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.
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.
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.
代谢手术对非肥胖型2型糖尿病（T2DM）是否有效尚不清楚，且胃癌胃切除术后常规重建对非肥胖T2DM患者T2DM改善效果不佳。本前瞻性单臂试验研究评估了胃切除术后采用长袢Roux-en Y重建术治疗非肥胖型胃癌患者T2DM的安全性和有效性。
纳入15例非肥胖T2DM合并胃癌患者。胃切除术后，采用Roux-en Y胃空肠吻合术或食管空肠吻合术重建胃肠道。胆胰支和Roux袢各长100至120厘米。
无手术相关死亡，但4例出现并发症（26.7%）。术前，抗糖尿病药物治疗下平均体重指数为25.2±3.4kg/m²，平均糖化血红蛋白（HbA1c）为7.7±1.4%。术后6个月，平均BMI降至21.7±3.1kg/m²（P<0.05），平均HbA1c降至6.3±0.8%（P<0.05）。研究结束时（随访时间12.5±5.5个月），11例患者（78.6%）在未使用任何抗糖尿病药物情况下HbA1c降至<6%。除1例术后4个月因复发死亡患者外，无患者术后出现贫血和/或营养不良。
胃切除术后长袢Roux-en Y重建术可行，有治愈非肥胖胃癌患者T2DM的潜力。需要进行随机对照试验来证实这一结果。
