Impact of Biliopancreatic Limb Length on Diabetes Following Distal Gastrectomy

The present study aimed to compare the changes in glucose metabolism and incretin hormone responses following long-limb bypass Roux-en-Y reconstruction with different biliopancreatic limb lengths after distal gastrectomy in gastric cancer patients with type 2 diabetes. This is a prospective, single-center, randomized controlled trial. Patients diagnosed with stage I gastric cancer and type 2 diabetes are eligible for the present study. Patients who will undergo laparoscopic distal gastrectomy for cancer located at the lower two-thirds of the stomach will only be included.

The reconstruction method will be randomly assigned among long-Roux limb Roux-en-Y (with 100 cm-long Roux limb & 50cm-long biliopancreatic limb) or long-biliopancreatic limb Roux-en-Y (with 50 cm-long Roux limb & 100cm-long biliopancreatic limb) reconstruction methods.

All the patients are subjected to a 75g-oral glucose tolerance test (OGTT) preoperatively, and at 3 months, 6 months postoperatively, and serum glucose, as well as incretin hormones, will be serially measured. Fecal samples will be obtained preoperatively and at 3 months after surgery for gut microbiota analyses.

Inclusion criteria

• Patients diagnosed with type 2 diabetes as well as pathologically proven gastric cancer of clinical stage I according to the AJCC 8th edition
• Those who are expected to undergo laparoscopic distal gastrectomy

Exclusion criteria

• baseline fasting C-peptide level < 1.0 ng/dL (who had the possibility of type 1 diabetes)
• previous radiotherapy or surgery at upper abdomen other than laparoscopic cholecystectomy
• other malignancies in recent 5 years
• vulnerable patients (pregnant women, those with cognitive impairment, etc)
• ECOG-PS ≥ 2
• participating in other clinical trials within 6 months