Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes / 고신대학교의과대학학술지

Objectives@#It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer. @*Methods@#A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC). @*Results@#The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery. @*Conclusions@#Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes / 고신대학교의과대학학술지

Objectives@#It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer. @*Methods@#A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC). @*Results@#The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery. @*Conclusions@#Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Clinicopathological Analysis of Recurrence in Stage 1 Gastric Cancer

PURPOSE: Recently, diagnosis of stage 1 gastric cancer has increased in number and prognosis is excellent when proper treatment is done. However, some patients have recurrence and their prognosis is poor. Thus, we investigated the risk factors of recurrence in stage 1 gastric cancer patients. METHODS: From January 2004 to December 2008, a total of 1,241 number patients were operated on for stage 1 gastric cancer at the Department of General Surgery, Kosin University Gospel Hospital. We reviewed the characteristics of all patients retrospectively and compared them to recurred group (n=24) and non-recurred group (n=1,114). We analyzed the risk factors associated with recurrence. RESULTS: Twenty-four patients with stage 1 gastric cancer were recurred after radical gastrectomy. Recurrence rate was 2.05%. The most common pattern of recurrence was hematogenous (41.7%), and lymphatic (20.8%), peritoneal seeding (16.7%), combined form (12.5%), and locoregional (8.3%). Five-year survival rate was 50.08% of recurrence group. Of clinicopathological factors, depth of invasion, lymph node metastasis, lymphatic involvement and tumor marker were statistically significant between recurred and other group. CONCLUSION: In this study, tumor marker, tumor depth, node status, lymphatic channel involvement were possible risk factors of recurrence for stage 1 gastric cancer. More intensive follow up and care is needed for those with such risk factors.

Relationship of the Nutritional Status at the Time of Admission to Mortality and the Length of the Hospital Stay

PURPOSE: The length of a patient's stay in a hospital is an indication of the patient's recovery rate. The length of the hospital stay has an important economic factor for hospitals. This study was conducted to determine the relationship of the nutritional status at the time of admission to mortality and the length of the hospital stay (LOHS). METHODS: The study subjects were 1,619 patients who suffered with cancer, were admitted to Kosin University Gospel Hospital during 2005 and they met the study criteria. The patients were classified to the not at risk group, the patients having one risk factor for malnutrition were the I group, the patients having two risk factors for malnutrition were the II group, the patients having three risk factors for malnutrition were the III group and the patients having 4 risk factors for malnutrition were the IV group, based on the established criteria of serum albumin or =240 mg/dl or or =120% or <90% ideal body weight. RESULTS: 24.3% of the patients were classified into the not at risk group, 37.6% were classified into the at risk group I, 24.2% were classified into the at risk group II, 10.3% were classified into the at risk group III and 3.6% were classified into the at risk group IV. The at risk group (at risk III, at risk IV) had a significantly higher prevalence of liver disease. The relationship between liver disease and low serum albu-min levels may have confounded the data. Although the estimated LOHS was similar in all the groups, the average length of stay was 14.4+/-16.38 days in the malnourished group (at risk group IV) compared to approximately 2.8 days in the not at risk group. The more nutritional risk factors the patients had, the longer was the LOHS and the mortality rates were higher. Correlation was not observed between the risk factors and the length of the hospital stay, as well as the lack of correlation with the mortality rate. CONCLUSION: These results suggest that a patient's nutritional status upon admission has an effect on the length of the hospital stay for patients with carcinoma.

Nutritional Status in Elderly Gastric Carcinoma

BACKGROUND: Malnutrition is one of the important factors influencing morbidity and mortality in elderly patients with gastric carcinoma. METHODS: Since September to December 2001, we investigated the nutritional parameters of 44 elderly patients with gastric carcinoma by measuring anthropometric and biochemical blood indices and assessing dietary intake along with subjective global assessment. RESULTS: The mean body mass index of subjects was below the physical average of korea on the base of 64 years old. The ratio of carbohydrate, protein and lipid to energy intake was 74.0:13.5:12.5(%). There were significantly positive correlations between three groups according to subjective global assessment and height, body weight, 1 month weight loss %, 6 month weight loss %, body mass index, transferrin and nutrient intake, such as energy, protein and niacin. CONCLUSION: Mean nutrient intake, such as total energy, protein and niacin appear to be related of subjective global assessment in elderly subjects. Nutritional assessment by nutrient intake should be done in elderly patients with gastric carcinoma and be supplied with adequate nutrition for them.