S1459 Endoscopic Resection Is Superior to Gastrectomy for Gastric Cancer Regarding the Risk of Incident Type 2 Diabetes: A Nationwide Cohort Study

Abstract

Introduction: Management of comorbidities in gastric cancer survivors is imperative, given increasing survival rate in patients with gastric cancer. Patients with gastric cancer are known to have higher risk of developing type 2 diabetes (T2D) compared to those without gastric cancer, but it is unknown whether the risk of incident T2D in patients with gastric cancer differs by treatment procedures. Methods: Using data from a nationwide cohort provided by the National Health Insurance Service in Korea, patients undergoing endoscopic submucosal dissection (ESD) or total gastrectomy (TG) for gastric cancer between 2004 to 2013 were identified. Exclusion criteria were patients who had history of other cancers or T2D, received adjuvant chemotherapy, died within 3 years after procedures. The risk of incident T2D after ESD or TG was estimated using multivariate Cox regression analyses adjusted for baseline characteristics, considering competing risks of incident T2D and death. Subgroup analyses were performed according to baseline age and sex. Results: Total of 3,006 patients undergoing ESD and 15,647 patients undergoing TG were included in this study. Compared to those undergoing ESD, patients undergoing TG had higher risk of incident T2D (hazard ratio [HR], 1.42; 95% confidence interval [95% CI], 1.26-1.58). Higher risk of incident T2D in patients undergoing TG remained significant across subgroups according to baseline age and sex. Conclusion: Patients undergoing ESD haver lower risk of developing T2D after procedure, compared to those undergoing TG. More careful postoperative care regarding glycemic control after TG is warranted. This study highlighted novel strength of endoscopic resection regarding risk of incident T2D and enabled more informed treatment decision for early gastric cancer patients.Figure 1.