Improving Diabetes by Reconstruction Methods in Gastric Cancer Patients With Diabetes Mellitus

The Effect and Mechanism of Improving Diabetes by Reconstruction Methods in Gastric Cancer Patients With DM Who Receive Surgical Treatment

This study is to investigate the effect of gastrectomy on remission of type 2 diabetes in patients with gastric cancer and type 2 diabetes, to investigate the mechanism of blood glucose alteration and intestinal hormonal signaling by the reconstruction methods, and to evaluate the applicability and efficacy of Roux-en-Y gastrojejunostomy after gastrectomy in gastric cancer patients with diabetes.

Purpose:

• To investigate the effect of gastrectomy on remission of type 2 diabetes in patients with gastric cancer and type 2 diabetes
• To investigate the mechanism of blood glucose alteration and intestinal hormonal signaling by the reconstruction methods
• To evaluate the applicability and efficacy of Roux-en-Y gastrojejunostomy after gastrectomy in gastric cancer patients with diabetes

Contents:

• Evaluation of the status of diabetes in gastric cancer patients with DM after gastrectomy

  • Comparison of two reconstruction types after gastrectomy Bypass duodenum and upper jejunum: Roux-en-Y gastrojejunostomy Preservation of duodenal passage: Gastroduodenostomy
  • Analysis for biochemical markers reflecting diabetic status: fasting glucose, postprandial 2h glucose, HbA1c, C-peptide, lipid profile

• Correlation of parameters associated with diabetes and GI hormones

  • Measurement of GI hormones which have an effect on glucose tolerance

    • Insulin, glucagon, IGF-1, GLP-1, Neuropeptide Y, Ghrelin, Leptin

  • Correlation of reconstruction methods, parameters of diabetes and GI hormone levels

  • Evaluation of mechanism of Roux-en-Y gastrojejunostomy on controlling diabetes

• Evaluation of Feasibility of Roux-en-Y gastrojejunostomy in gastric cancer surgery in patients with DM

  • Degree of high blood glucose control, the amount of antidiabetic medication, costs for DM treatment, quality of life assessment
  • Analysis for the mechanism of gastrointestinal physiology to diabetes control

Inclusion Criteria:

• Patient who are older than 20 years and younger than 80 years
• Histologically confirmed gastric adenocarcinoma located lower one third of stomach
• Postoperative confirmed pT1N0, pT2N0, pT1N1
• Informed consent

Exclusion Criteria:

• Previous history of treatment for other malignancy or inflammatory disease
• Preoperative uncontrolled serious comorbidity
• Vulnerable Subjects(pregnant women, children, cognitively impaired persons etc.)
• Patient who experience any complications requiring reoperation following gastrectomy