Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study

Abstract

Background: Sleeve gastrectomy is an effective surgical option for morbid obesity, and it improves glucose homeostasis. In patients with gastric cancer and type 2 diabetes mellitus (DM), gastrectomy, including total gastrectomy, is beneficial for glycemic control.

Objective: This study aims to clarify the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative DM in patients with gastric cancer.

Methods: This retrospective, single-center, cohort study included 715 patients without DM who underwent total gastrectomy at the Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. Patients underwent reconstruction by Roux-en-Y (RY) gastric bypass or other surgical techniques (OT), with DM onset determined by hemoglobin A1c levels or medical records. Analyses included 2-sample, 2-tailed t tests; χ2 tests; and the Kaplan-Meier method with log-rank tests to compare the onset curves between the RY and OT groups, along with additional curves stratified by sex. A Swimmer plot for censoring and new-onset DM was implemented.

Results: Stratified data analysis compared the RY and OT reconstruction methods. The hazard ratio was 1.52 (95% CI 1.06-2.18; P=.02), which indicated a statistically significant difference in the incidence of new-onset diabetes between the RY and OT groups in patients with gastric cancer. The hazard ratio after propensity score matching was 1.42 (95% CI 1.09-1.86; P=.009).

Conclusions: 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 DM after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative DM, particularly in patients with a family history of DM. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative DM.

Keywords: diabetes mellitus; gastrectomy; gastric cancer surgery; glucose metabolism; postoperative diabetes onset; surgery outcomes.

Figure 1.. Kaplan-Meier curve of new-onset DM in the RY and OT groups. DM: diabetes mellitus; OT: other surgical techniques; RY: Roux-en-Y.

Figure 2.. Swimmer plot of new-onset DM and death. DM: diabetes mellitus; OT: other surgical techniques; RY: Roux-en-Y.

Figure 3.. Density histogram (A) before and (B) after propensity score matching, and (C) Kaplan-Meier curve of new-onset DM after propensity score matching. DM: diabetes mellitus; OT: other surgical techniques; RY: Roux-en-Y.

Figure 4.. Kaplan-Meier curve of new-onset DM stratified by sex: (A) male and (B) female. DM: diabetes mellitus; OT: other surgical techniques; RY: Roux-en-Y.