Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 105514
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.105514
Remission of type 2 diabetes one year after esophagectomy with gastric conduit reconstruction: A prospective cohort study
Hua-Jie Xing, Meng-Yu Hu, Yue-Quan Jiang, Xin-Hua Li, Bin Zhu, Zhi-Qiang Wang
Hua-Jie Xing, Yue-Quan Jiang, Bin Zhu, Zhi-Qiang Wang, Department of Thoracic Surgery, Chongqing University Cancer Hospital, Chongqing 400030, China
Meng-Yu Hu, Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing 400030, China
Xin-Hua Li, Department of Thoracic Surgery, People’s Hospital of Dali District, Dali 671000, Yunnan Province, China
Co-first authors: Hua-Jie Xing and Meng-Yu Hu.
Co-corresponding authors: Bin Zhu and Zhi-Qiang Wang.
Author contributions: Xing HJ contributed to conceptualization, formal analysis, and writing original draft; Hu MY, Zhu B, and Li XH contributed to data curation; Jiang YQ contributed to conceptualization; Li XH and Wang ZQ contributed to funding acquisition; Hu MY, Jiang YQ, Li XH, Zhu B, and Wang ZQ contributed to reviewing and editing.
Supported by the Technological innovation project of Shapingba District, No. 2024111; and the Research Promotion Fund of Chongqing University Cancer Hospital, No. 2023nlts008.
Institutional review board statement: The institutional research ethics committee approved this study on January 1, 2018 (No. CZLS2022166-A).
Clinical trial registration statement: The work was registered with the Research Registry website (https://www.researchregistry.com/browse-the-registry#home/) and the unique identifying number is 10673.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data of this study are available upon reasonable request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Qiang Wang, Department of Thoracic Surgery, Chongqing University Cancer Hospital, No. 181 Hanyu Street, Shapingba District, Chongqing 400030, China. zhiqiangwang@21cn.com
Received: January 27, 2025
Revised: March 22, 2025
Accepted: April 29, 2025
Published online: June 27, 2025
Processing time: 125 Days and 20.8 Hours
Abstract
BACKGROUND

Type 2 diabetes (T2D) remission has been widely reported after bariatric surgery, but rarely reported after esophagectomy.

AIM

To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.

METHODS

In this prospective study, consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months, 6 months, and 12 months postoperatively. Remission of T2D is defined as glycated hemoglobin (HbA1c) values below 6.5% without glucose-lowering medications. Related clinical information were recorded and analyzed.

RESULTS

A total of 187 patients were included. Of these patients, 24 (12.8%) discontinued antidiabetic drugs and maintained HbA1c values below 6.5% 1 year after surgery. At baseline, patients with T2D remission were younger (63.0 ± 5.2 years vs 67.0 ± 6.1 years, P = 0.002), had higher body mass index values (body weight 68.6 ± 11.1 kg vs 61.2 ± 9.3 kg, P = 0.001; body mass index 25.5 ± 2.4 kg/m2vs 23.8 ± 3 kg/m2, P = 0.011), shorter duration of T2D (4.9 ± 3.9 years vs 7.1 ± 3.7 years, P = 0.008) and higher preoperative HbA1c (8.5% ± 1.7% vs 7.7% ± 1.3%, P = 0.042). Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.

CONCLUSION

This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction, and remission is more frequent in patients with younger age and greater body weight.

Keywords: Esophagectomy; Gastric conduit reconstruction; Type 2 diabetes; Remission; Bariatric surgery

Core Tip: In this multi-center prospective study, esophageal cancer patients with type 2 diabetes (T2D) who received esophagectomy with gastric conduit reconstruction were included and followed. The results showed that diabetes remission occurred in 12.8% (24/187) of patients 1 year after surgery. Multivariate logistic regression analysis demonstrated that younger age and greater body weight were independent predictors of T2D remission after surgery. The preferential use of a relatively narrow gastric tube during esophagectomy for patients with esophageal cancer and T2D has the potential to improve patient care and long-term prognosis. Adjustments in the prescription of glucose-lowering drugs should be tailored after esophagectomy.