Does Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorHAYASHI, Silvia Y.
dc.contributor.authorFAINTUCH, Joel
dc.contributor.authorYAGI, Osmar K.
dc.contributor.authorYAMAGUCHI, Camila M.
dc.contributor.authorFAINTUCH, Jacob J.
dc.contributor.authorCECCONELLO, Ivan
dc.date.accessioned2016-07-18T12:12:52Z
dc.date.available2016-07-18T12:12:52Z
dc.date.issued2013
dc.description.abstractCancer gastrectomy seems to benefit type 2 diabetes; however, results are conflicting. In a prospective protocol, including retrospective information, the aim was assessment of changes in glucose profile in patients with both normal and deranged preoperative glucose homeostasis. Patients (N = 164) with curative subtotal or total Roux-en-Y gastrectomy for gastric cancer (n = 92), or Roux-en-Y gastric bypass for morbid obesity (RYGB, n = 72) were preoperatively classified into diabetes (including prediabetes) and control group. Postoperative diabetes outcome was stratified as responsive or refractory, and results in controls were correspondingly defined as stable or new-onset diabetes (NOD), according to fasting blood glucose and HbA1c. Dietary intake and biochemical profile was documented. Statistical methods included analysis of variance, multivariate logistic regression, and propensity score matching according to postoperative weight loss. Age of cancer cases was 67.9 +/- A 11.5 years, 56.5 % males, initial body mass index (BMI) 24.7 +/- A 3.7, current BMI 22.6 +/- A 3.8 kg/m(2), and follow-up 102.1 +/- 51.0 months, whereas in bariatric individuals age was 51.4 +/- A 10.1 years, 15.3 % males, initial BMI 56.7 +/- A 12.2, current BMI 34.8 +/- A 8.1 kg/m(2), and follow-up 104.1 +/- 29.7 months. Refractory disease corresponded to 62.5 % (cancer) versus 23.5 % (bariatric) (P = 0.019), whereas NOD represented 69.2 versus 23.8 % respectively (P = 0.016). Weight loss (Delta BMI) was associated with diabetes response in cancer patients but not with NOD. No difference between subtotal and total gastrectomy was detected. Divergent outcomes (refractory vs. responsive) were confirmed in BMI-similar, propensity-matched cancer gastrectomy patients with preoperative diabetes, consistent with weight-dependent and -independent benefits. Diabetes response was confirmed, however with more refractory cases than in bariatric controls, whereas high proportions of NOD occurred. Such dichotomous pattern seems unusual albeit consistent with previous studies.
dc.description.indexMEDLINE
dc.description.sponsorshipCAPES
dc.description.sponsorshipCNPq [302915/2011-7]
dc.identifier.citationSURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.27, n.8, p.2829-2835, 2013
dc.identifier.doi10.1007/s00464-013-2829-3
dc.identifier.issn0930-2794
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/14242
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofSurgical Endoscopy and Other Interventional Techniques
dc.rightsrestrictedAccess
dc.rights.holderCopyright SPRINGER
dc.subjectDiabetes mellitus
dc.subjectNew-onset diabetes
dc.subjectGastric cancer
dc.subjectSubtotal gastrectomy
dc.subjectTotal gastrectomy
dc.subjectFasting blood glucose
dc.subjectHbA1c
dc.subjectRoux-en-Y gastric bypass
dc.subject.otherrandomized-controlled-trial
dc.subject.othertype-2 diabetes-mellitus
dc.subject.othersubtotal gastrectomy
dc.subject.othersleeve gastrectomy
dc.subject.otherinsulin
dc.subject.otherbypass
dc.subject.otherpathophysiology
dc.subject.otherhyperglycemia
dc.subject.othersecretion
dc.subject.otherobesity
dc.subject.wosSurgery
dc.titleDoes Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus8
hcfmusp.contributor.author-fmusphcSILVIA YOKO HAYASHI
hcfmusp.contributor.author-fmusphcJOEL FAINTUCH
hcfmusp.contributor.author-fmusphcOSMAR KENJI YAGI
hcfmusp.contributor.author-fmusphcCAMILA MICHIKO YAMAGUCHI
hcfmusp.contributor.author-fmusphcJACOB JEHUDA FAINTUCH
hcfmusp.contributor.author-fmusphcIVAN CECCONELLO
hcfmusp.description.beginpage2829
hcfmusp.description.endpage2835
hcfmusp.description.issue8
hcfmusp.description.volume27
hcfmusp.origemWOS
hcfmusp.origem.pubmed23436087
hcfmusp.origem.scopus2-s2.0-84881372100
hcfmusp.origem.wosWOS:000321961700022
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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