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Study objective

Sleeve gastrectomy is effective in morbid obesity, and it improves glucose homeostasis. In gastric cancer patients with type 2 diabetes mellitus, gastrectomy, including total gastrectomy (TG), is beneficial for glycaemic control. However, the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative diabetes in gastric cancer patients are unclear. This study investigated the development of new-onset diabetes in these patients, focusing on different reconstruction methods.

Design

A comparative study

Setting

Electrical medical records

Patients

This study included 715 patients without diabetes who underwent TG at Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019.

Interventions

Patients underwent reconstruction by Roux-en-Y (RY) or other surgical techniques (OT), with diabetes onset determined by HbA1c levels or medical records.

Measurements

Analyses included two-sample t-tests, chi-squared tests, and the Kaplan-Meier method with log-rank tests to compare the onset curves between the two groups.

Main Results

Stratified data analysis compared the RY and OT reconstruction methods. Log-rank test results (P=0.0217) indicated a statistically significant difference in the incidence of new-onset diabetes between RY and OT groups in gastric cancer patients.

Conclusion

This first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset diabetes mellitus after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative diabetes, particularly in patients with a family history of diabetes mellitus. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative diabetes.