Beyond Oncologic Benefit: Diabetes Remission Following Long-Limb Roux-en-Y Reconstruction in Laparoscopic Gastric Cancer Surgery.

Abstract

Introduction: Few studies have compared conventional Roux-en-Y (RNY) reconstruction with oncometabolic surgical techniques for postoperative glycemic control in patients with gastric cancer and type 2 diabetes. This study evaluates the impact of long-limb (oncometabolic) RNY reconstruction on type 2 diabetes remission and glycemic control compared with the conventional method in patients undergoing laparoscopic radical gastrectomy. Materials and Methods: Between 2020 and 2024, 44 patients with gastric cancer and type 2 diabetes were enrolled at our institution. Of these, 19 patients underwent laparoscopic radical gastrectomy with oncometabolic RNY reconstruction, and 25 patients received conventional RNY reconstruction. Demographic data (age, gender, and BMI), preoperative glycemic parameters (fasting blood sugar and HbA1c), and tumor characteristics were recorded. Comparative analysis assessed diabetes treatment outcomes in the first postoperative year, including antidiabetic medication use, insulin requirements, and diabetes remission rates. Results: Diabetes remission occurred in 52.6% of the oncometabolic surgery group compared with 20% in the conventional RNY group (P = .024). Multivariate logistic regression showed that oncometabolic surgery increased remission likelihood by 5.75 times (OR = 5.75; 95% CI: 1.17 to 28.21; P = .03). Antidiabetic medication use decreased by 78.9% in the oncometabolic group versus 24% in the conventional group (P = .001). Insulin requirements dropped from 36.8% to 5.3% in the oncometabolic group (P = .031). Conclusions: Oncometabolic surgery provides significant advantages in gastric cancer patients not only from an oncological perspective but also from a metabolic perspective.