|
1
|
Lee YK, Lee EK, Lee YJ, Eom BW, Yoon HM, Kim YI, Cho SJ, Lee JY, Kim CG, Kong SY, Yoo MK, Hwangbo Y, Kim YW, Choi IJ, Kim HJ, Kwak MH, Ryu KW. Metabolic Effects of Gastrectomy and Duodenal Bypass in Early Gastric Cancer Patients with T2DM: A Prospective Single-Center Cohort Study. J Clin Med 2021; 10:jcm10174008. [PMID: 34501456 PMCID: PMC8432535 DOI: 10.3390/jcm10174008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
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.
Collapse
Affiliation(s)
- Young Ki Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
| | - Eun Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
| | - You Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Correspondence: (Y.J.L.); (K.W.R.); Tel.: +82-31-920-1644 (Y.J.L.); +82-31-920-1628 (K.W.R.)
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Hong Man Yoon
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Young-Il Kim
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Soo Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea; (H.M.Y.); (Y.-I.K.); (S.-Y.K.)
- Department of Laboratory Medicine, National Cancer Center, Goyang 10408, Korea
| | - Min Kyong Yoo
- Department of Clinical Nutrition, National Cancer Center, Goyang 10408, Korea;
| | - Yul Hwangbo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (Y.K.L.); (E.K.L.); (Y.H.)
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Hak Jin Kim
- Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (H.J.K.); (M.H.K.)
| | - Mi Hyang Kwak
- Division of Cardiology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea; (H.J.K.); (M.H.K.)
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang 10408, Korea; (B.W.E.); (S.J.C.); (J.Y.L.); (C.G.K.); (Y.-W.K.); (I.J.C.)
- Correspondence: (Y.J.L.); (K.W.R.); Tel.: +82-31-920-1644 (Y.J.L.); +82-31-920-1628 (K.W.R.)
| |
Collapse
|