Feasibility of Roux-en-Y reconstruction with a long biliopancreatic limb following distal gastrectomy in nonobese patients with gastric cancer and type 2 diabetes

This study aims to evaluate the safety of using an elongated biliopancreatic limb (BPL) of 100 cm in Roux-en-Y reconstruction following distal gastrectomy in patients with gastric cancer (GC) and type 2 diabetes (T2D) as well as the feasibility of subsequent randomized controlled trial protocols. Nine eligible patients with stage I GC and T2D, body mass index < 30 kg/m2, were prospectively recruited. The safety of the investigational procedure was assessed based on postoperative morbidity within 30 days and changes in nutritional parameters at 3 months. Participants underwent preoperative and 3-month postoperative oral glucose tolerance tests (OGTT) to evaluate the changes in serum glucose trajectories and tolerance to the test. One patient required reoperation due to bowel obstruction. Participants experienced a median total weight loss of 4.6% (interquartile range [IQR] 2.3–8.3) and a median decrease in HbA1c of 0.5% (IQR, 0.0–0.9) at 3 months. Four achieved HbA1c < 6.5% without medication. A significant reduction in 2hr-plasma glucose levels during OGTT was observed at 3 months postsurgery compared to the baseline. One patient experienced asymptomatic hypoglycemia at 120 min during OGTT at 3 months postsurgery. Nutritional indices remained stable, except for a significant decrease in hemoglobin levels, which remained within the normal range. A 100 cm-long BPL was associated with acceptable short-term safety without a significant escalation in technical or nutritional complications among non-obese GC patients with T2D.