Abstract
We evaluated the metabolic effects of gastrectomies and endoscopic submucosal dissections (ESDs) in early gastric cancer (EGC) patients with type 2 diabetes mellitus (T2DM). Forty-one EGC patients with T2DM undergoing gastrectomy or ESD were prospectively evaluated. Metabolic parameters in the patients who underwent gastrectomy with and without a duodenal bypass (groups 1 and 2, n = 24 and n = 5, respectively) were compared with those in patients who underwent ESD (control, n = 12). After 1 year, the proportions of improved/equivocal/worsened glycemic control were 62.5%/29.2%/8.3% in group 1, 40.0%/60.0%/0.0% in group 2, and 16.7%/50.0%/33.3% in the controls, respectively (p = 0.046). The multivariable ordered logistic regression analysis results showed that both groups had better 1-year glycemic control. Groups 1 and 2 showed a significant reduction in postprandial glucose (−97.9 and −67.8 mg/dL), body mass index (−2.1 and −2.3 kg/m2), and glycosylated hemoglobin (group 1 only, −0.5% point) (all p < 0.05). Furthermore, improvements in group 1 were more prominent when preoperative leptin levels were high (p for interaction < 0.05). Metabolic improvements in both groups were also observed for insulin resistance, leptin, plasminogen activator inhibitor-1, and resistin. Gastrectomy improved glycemic control and various metabolic parameters in EGC patients with T2DM. Patients with high leptin levels may experience greater metabolic benefits from gastrectomy with duodenal bypass.
Highlights
Gastric cancer is the most frequently diagnosed cancer in Korea and has the fifthhighest incidence among newly diagnosed cancer cases worldwide [1,2]
The metabolic improvement by gastrectomy was significant in terms of the PP2, HbA1c, and BMI, as well as some metabolic hormones and adipokines, such as leptin and plasminogen activator inhibitor-1 (PAI-1)
The patients with higher preoperative leptin levels experienced a greater metabolic benefit from gastrectomy with duodenal bypass versus endoscopic submucosal dissections (ESDs) than did those with lower leptin levels; in this subgroup, the probability for better 1-year glycemic control status was much higher and the degree of improvement in PP2 and BMI was more pronounced. It is well established in meta-analyses of randomized controlled trials (RCTs) that gastrectomy, performed as bariatric surgery, is excellent at improving or alleviating serum glucose in obese Type 2 diabetes mellitus (T2DM) patients compared to medical therapy [20,21]
Summary
Gastric cancer is the most frequently diagnosed cancer in Korea and has the fifthhighest incidence among newly diagnosed cancer cases worldwide [1,2]. While the incidence of gastric cancer has steadily decreased, the number of gastric cancer survivors has increased due to early diagnosis and improved treatment techniques [1,2,3]. In Korea, the 5-year survival rate of gastric cancer has dramatically improved from 43.9% in 1993–1995 to 76.5% in 2013–2017, and the number of gastric cancer survivors reached about 300,000 in 2017 [1]. The prevalence of T2DM has been increasing worldwide, and it reached 13.8% in 2018 in Korea [7,8]. Patients with T2DM are at a higher risk for gastric cancer development, and the incidence of T2DM increases after gastric cancer development [9,10]. Proper management of T2DM is an important issue in many gastric cancer patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
