Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

doi:10.3748/wjg.v18.i1.49

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Jan 7, 2012 (publication date) through Apr 23, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jan 7, 2012; 18(1): 49-54
Published online Jan 7, 2012. doi: 10.3748/wjg.v18.i1.49

Table 1 Clinical findings [n = 403, n (%) or mean ± SD]

Gender	Female	96 (23.8)
	Male	307 (76.2)
Age at OP (yr)		63.8 ± 7.6
OP type	B-I	165 (40.9)
	B-II	134 (33.3)
	R-Y	104 (25.8)
Extent of gastrectomy	Subtotal (B-I, B-II)	299 (74.2)
	Total (R-Y)	104 (25.8)
Duodenal bypass	Bypass – (B-I)	165 (40.9)
	Bypass + (B-II, R-Y)	238 (59.1)
Pre-OP BMI (kg/m²)		24.7 ± 3.0 (18.4-39.9)
Current BMI (kg/m²)		22.2 ± 2.9 (13.5-35.3)
BMI reduction ratio¹ (%)		9.8 ± 8.6
Pre-OP	Oral diabetic agent	368 (91.3)
diabetic therapy	Insulin	35 (8.7)
F/U duration (mo)		33.7 ± 20.6 (5.5-81.8)
Diabetes course	Worse	38 (9.9)
	Same	172 (44.7)
	Improvement	117 (30.4)
	Resolution	58 (15.1)

¹BMI reduction ratio (%) = -[(Current BMI - Pre-OP BMI)/Pre-OP BMI] × 100. OP: Operation; BMI: Body mass index; F/U: Follow up; B-I : Billroth I; B-II: Billroth II; R-Y: Roux-en-Y.

Table 2 Univariate analysis [n = 403, n (%) or mean ± SD]

		Diabetes course				P value
		Worse	Same	Improvement	Resolution
Gender	Female	8 (8.6)	36 (38.7)	34 (36.6)	15 (16.1)	0.180
	Male	30 (10.3)	136 (46.6)	83 (28.4)	43 (14.7)
Age at OP (yr)		62.6 ± 7.6	64.2 ± 7.4	63.5 ± 7.4	62.5 ± 8.4	0.453
OP type	B-I^a	20 (12.4)	82 (50.9)	42 (26.1)	17 (10.6)	0.001
	B-II^a	10 (8.0)	59 (47.2)	42 (33.6)	14 (11.2)	0.006
	R-Y	8 (8.1)	31 (31.3)	33 (33.3)	27 (27.3)
Extent of gastrectomy	B-I and B-II (subtotal)	30 (10.5)	141 (49.3)	84 (29.4)	31 (10.8)	< 0.001
	R-Y (total)	8 (8.1)	31 (31.3)	33 (33.3)	27 (27.3)
Duodenal bypass	B-I (bypass -)	20 (12.4)	82 (50.9)	42 (26.1)	17 (10.6)	0.002
	B-II and R-Y (bypass +)	18 (8.0)	90 (40.2)	75 (33.5)	41 (18.3)
Pre-OP BMI (kg/m²)		23.4 ± 2.5	24.9 ± 2.6	24.8 ± 3.5	24.9 ± 3.5	0.127
Current BMI (kg/m²)		21.7 ± 2.7	22.7 ± 2.6	22.2 ± 3.2	21.2 ± 2.9	0.038
BMI reduction ratio¹ (%)		6.8 ± 10.2	8.5 ± 7.3	10.4 ± 8.7	14.4 ± 8.5	< 0.001
Pre-OP diabetic	Oral diabetic agent	38 (10.8)	159 (45.3)	99 (28.2)	55 (15.7)	0.147
regimen	Insulin	0 (0.0)	13 (38.2)	18 (52.9)	3 (8.8)
F/U duration (mo)		36.4 ± 18.2	37.2 ± 21.6	30.0 ± 20.1	28.3 ± 17.8	0.001

^aP = 0.161, B-I vs B-II.

¹BMI reduction ratio (%) = -[(Current BMI - Pre-OP BMI)/Pre-OP BMI] × 100. OP: Operation; BMI: Body mass index; F/U: Follow up; B-I : Billroth I; B-II: Billroth II; R-Y: Roux-en-Y.

Table 3 Multivariate analysis (n = 403)

	P value	B-estimation	SE	Contribution degree
Current BMI (kg/m²)	0.454	0.028	0.037
BMI reduction ratio¹ (%)	< 0.001	0.051	0.013	3.948
F/U duration (mo)	0.007	-0.013	0.005	-2.703
OP type
B-I	0.006	-0.714	0.258	-2.770
B-II	0.070	-0.473	0.262
R-Y

Current BMI (kg/m²)	0.478	0.026	0.037
BMI reduction ratio¹ (%)	< 0.001	0.052	0.013	4.031
F/U duration (mo)	0.006	-0.013	0.005	-2.727
Extent of gastrectomy
Subtotal (B-I, B-II)	0.011	-0.597	0.234	-2.553
Total (R-Y)

Current BMI (kg/m²)	0.657	0.016	0.037
BMI reduction ratio¹(%)	< 0.001	0.054	0.013	4.181
F/U duration (mo)	0.005	-0.013	0.005	-2.811
Duodenal bypass
Bypass – (B-I)	0.039	-0.416	0.202	-2.061
Bypass + (B-II, R-Y)

OP: Operation; BMI: Body mass index; F/U: Follow up; B-I : Billroth I; B-II: Billroth II; R-Y: Roux-en-Y;

¹BMI reduction ratio (%) = -[(Current BMI - Pre-OP BMI)/Pre-OP BMI] × 100.

Table 4 Clinical findings in subgroup analysis [body mass index reduction ratio < 10%, n = 206, n (%) or mean ± SD]

Gender	Female	38 (18.4)
	Male	168 (81.6)
Age at OP (yr)
OP type	B-I	105 (51.0)
	B-II	68 (33.0)
	R-Y	33 (16.0)
Extent of gastrectomy	Subtotal (B-I, B-II)	173 (84.0)
	Total (R-Y)	33 (16.0)
Duodenal bypass	Bypass – (B-I)	105 (51.0)
	Bypass + (B-II, R-Y)	101 (49.0)
Pre-OP BMI (kg/m²)		23.8 ± 2.8 (18.4-32.6)
Current BMI (kg/m²)		23.0 ± 2.7 (21.8-32.5)
BMI reduction ratio¹ (%)		3.4 ± 5.4
Pre-OP diabetic regimen	Oral diabetic agent	186 (90.3)
	Insulin	20 (9.7)
F/U duration (mo)		35.7 ± 20.7 (5.5-81.1)
Diabetes course	Worse	24 (12.1)
	Same	102 (51.5)
	Improvement	57 (28.8)
	Resolution	15 (7.6)

OP: Operation; BMI: Body mass index; F/U: Follow up; B-I : Billroth I; B-II: Billroth II; R-Y: Roux-en-Y;

¹BMI reduction ratio (%) = -[(Current BMI - Pre-OP BMI)/Pre-OP BMI] × 100.

Table 5 Subgroup analysis [body mass index reduction ratio < 10%, n = 206, n (%) or mean ± SD]

		Diabetes course				P value
		Worse	Same	Improvement	Remission
Gender	Female	3 (8.1)	17 (45.9)	14 (37.8)	3 (8.1)	0.190
	Male	21 (13.0)	85 (52.8)	43 (26.7)	12 (7.5)
Age at OP (yr)		61.9 ± 8.1	63.9 ± 8.0	63.8 ± 7.5	61.1 ± 9.3	0.976
OP type	B-I^a	14 (13.5)	56 (53.8)	27 (26.0)	7 (6.7)	0.076
	B-II^a	7 (11.3)	33 (53.2)	18 (29.0)	4 (6.5)	0.181
	R-Y	3 (9.4)	13 (40.6)	12 (37.5)	4 (12.5)
Extent of gastrectomy	Subtotal (B-I, B-II)	21 (12.7)	89 (53.6)	45 (27.1)	11 (6.6)	0.084
	Total (R-Y)	3 (9.4)	13 (40.6)	12 (37.5)	4 (12.5)
Duodenal bypass	Bypass – (B-I)	14 (13.5)	56 (53.8)	27 (26.0)	7 (6.7)	0.250
	Bypass + (B-II, R-Y)	10 (10.6)	46 (48.9)	30 (31.9)	8 (8.5)
Pre-OP BMI (kg/m²)		22.7 ± 2.3	24.3 ± 2.7	23.8 ± 3.0	22.2 ± 2.8	0.615
Current BMI (kg/m²)		22.3 ± 2.2	23.4 ± 2.6	23.0 ± 3.1	21.3 ± 2.6	0.310
BMI reduction ratio¹ (%)		1.5 ± 6.6	3.7 ± 4.5	3.6 ± 5.9	4.2 ± 4.6	0.183
Pre-OP	Oral diabetic agent	24 (13.5)	93 (52.2)	47 (26.4)	14 (7.9)	0.080
diabetic
regimen	Insulin	0 (0.0)	9 (45.0)	10 (50.0)	1 (5.0)
F/U duration (mo)		37.7 ± 17.6	38.8 ± 21.7	30.7 ± 20.7	28.7 ± 14.1	0.022

^aP = 0.674, B-I vs B-II; OP: Operation; BMI: Body mass index; F/U: Follow up; B-I : Billroth I; B-II: Billroth II; R-Y: Roux-en-Y;

¹BMI reduction ratio (%) = -[(Current BMI - Pre-OP BMI)/Pre-OP BMI] × 100.

Citation: Kim JW, Cheong JH, Hyung WJ, Choi SH, Noh SH. Outcome after gastrectomy in gastric cancer patients with type 2 diabetes. World J Gastroenterol 2012; 18(1): 49-54
URL: https://www.wjgnet.com/1007-9327/full/v18/i1/49.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i1.49