Clinical course of diabetes after gastrectomy according to type of reconstruction in patients with concurrent gastric cancer and type 2 diabetes.

ABSTRACT

BACKGROUND: This study was conducted to evaluate course of diabetes after gastrectomy according to type of reconstruction performed for gastric cancer in patients with type 2 diabetes. METHODS: In total, 292 patients with concurrent gastric cancer and type 2 diabetes who underwent curative surgery from January 2000 to December 2010 were enrolled in this retrospective study. No surgery-related complications, tumor recurrence, or distant metastasis occurred within 2 years after surgery. The patients' clinical characteristics were compared according to reconstruction type. Their diabetes status was assessed 1, 6, 12, and 24 months postoperatively. RESULTS: Of the 292 patients, 126 underwent distal gastrectomy with Billroth I reconstruction, 103 underwent distal gastrectomy with Billroth II reconstruction, and 63 underwent total gastrectomy with Roux-en-Y reconstruction. The operation type was significantly correlated with the outcome of type 2 diabetes mellitus 2 years postoperatively (P < 0.05), while sex, age at operation, duration of diabetes, anti-diabetes treatment method, preoperative body mass index, preoperative fasting blood glucose level, and preoperative diabetes control were not (P > 0.05). The rate of remission and improvement was significantly different at 1, 6, 12, and 24 months postoperatively in the Billroth I group (P < 0.05), but not in the Billroth II group (P > 0.05). CONCLUSIONS: Patients with concurrent gastric cancer and type 2 diabetes can exhibit remission of diabetes after gastrectomy. Total gastrectomy with Roux-en-Y reconstruction was associated with the highest remission rate, while distal gastrectomy with Billroth I reconstruction showed a variable rate of remission and improvement postoperatively.