Visceral fat changes after distal gastrectomy according to type of reconstruction procedure for gastric cancer

World Journal of Surgical Oncology

Osamu Ishikawa¹  Hiroaki Ohigashi¹  Masayuki Ohue¹  Shingo Noura¹  Tatsushi Shingai¹  Masaaki Motoori¹  Kentaro Kishi¹  Masahiko Yano¹  Isao Miyashiro¹  Koji Tanaka¹ 

[1] Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan

关键词: Visceral fat;    Reconstruction;    Gastrectomy;   

Others  :  823771
DOI  :  10.1186/1477-7819-11-146

 received in 2013-01-11, accepted in 2013-05-12,  发布年份 2013

【 摘 要 】

Background

Noncancerous causes of death, such as cerebrovascular or cardiac disease, are not rare in patients with gastric cancer who had undergone curative gastrectomy. Metabolic syndrome, characterized by visceral fat accumulation, is a risk factor for cerebrovascular and cardiac diseases. However, there is limited information on the effects of reconstruction procedures on changes in visceral fat after distal gastrectomy. The aim of this study was to analyze the impact of the reconstruction procedure (Roux-en-Y reconstruction (RY) and Billroth I reconstruction (BI)) on changes in visceral fat, as determined using computed tomography.

Methods

The study subjects were 152 patients with gastric cancer who underwent distal gastrectomy with lymphadenectomy between 2002 and 2007. The visceral fat area was measured for one cross-sectional computed tomogram obtained at the level of the umbilicus.

Results

Adjuvant chemotherapy (yes vs. no, P = 0.0006), type of reconstruction (BI vs. RY, P = 0.0146), field of lymph node dissection (P = 0.0020), omentectomy (yes vs. no, P = 0.0003), and pathological stage (1/2 vs. 3/4; P = 0.0023) correlated significantly with postoperative visceral fat loss. Multivariate logistic regression analysis identified reconstruction (BI vs. RY; P = 0.0232) and adjuvant chemotherapy (yes vs. no, P = 0.0330) as the significant determinants of visceral fat loss after surgery.

Conclusions

Visceral fat loss after RY was larger than that after BI. Further prospective studies are needed to confirm the effects of reconstruction after distal gastrectomy on visceral fat.

【 授权许可】

   
2013 Tanaka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 11.

【 参考文献 】

• [1]Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, Katai H, Tsujitani S, Kodera Y, Seto Y, Kaminishi M: Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer 2011, 14:301-316.
• [2]Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, Nagahori Y, Hosoi H, Takahashi M, Kito F, Shimada H: Significance of long-term follow-up of early gastric cancer. Ann Surg Oncol 2006, 13:363-369.
• [3]Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S: Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987, 36:54-59.
• [4]Fujimoto WY, Newell-Morris LL, Grote M, Bergstrom RW, Shuman WP: Visceral fat obesity and morbidity: NIDDM and atherogenic risk in Japanese American men and women. Int J Obes 1991, 15(Suppl 2):41-44.
• [5]Marcus MA, Murphy L, Pi-Sunyer FX, Albu JB: Insulin sensitivity and serum triglyceride level in obese white and black women: relationship to visceral and truncal subcutaneous fat. Metabolism 1999, 48:194-199.
• [6]Lee SE, Lee JH, Ryu KW, Nam B, Kim CG, Park SR, Kook MC, Kim YW: Changing pattern of postoperative body weight and its association with recurrence and survival after curative resection for gastric cancer. Hepatogastroenterology 2012, 59:430-435.
• [7]Moriwaki Y, Kunisaki C, Kobayashi S, Harada H, Imai S, Kasaoka C: Does body mass index (BMI) influence morbidity and long-term survival in gastric cancer patients after gastrectomy? Hepatogastroenterology 2003, 50:284-288.
• [8]Armbrecht U, Lundell L, Lindstedt G, Stockbruegger RW: Causes of malabsorption after total gastrectomy with Roux-en-Y reconstruction. Acta Chir Scand 1988, 154:37-41.
• [9]Bradley EL 3rd, Isaacs J, Hersh T, Davidson ED, Millikan W: Nutritional consequences of total gastrectomy. Ann Surg 1975, 182:415-429.
• [10]Friess H, Bohm J, Muller MW, Glasbrenner B, Riepl RL, Malfertheiner P, Buchler MW: Maldigestion after total gastrectomy is associated with pancreatic insufficiency. Am J Gastroenterol 1996, 91:341-347.
• [11]Adams JF: The clinical and metabolic consequences of total gastrectomy. I. Morbidity, weight, and nutrition. Scand J Gastroenterol 1967, 2:137-149.
• [12]Liedman B, Andersson H, Bosaeus I, Hugosson I, Lundell L: Changes in body composition after gastrectomy: results of a controlled, prospective clinical trial. World J Surg 1997, 21:416-420. Discussion 420–421
• [13]Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A: Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 2005, 9:313-319.
• [14]Japanese Gastric Cancer A: Japanese Classification of Gastric Carcinoma - 2nd English edition. Gastric Cancer 1998, 1:10-24.
• [15]Yoshizumi T, Nakamura T, Yamane M, Islam AH, Menju M, Yamasaki K, Arai T, Kotani K, Funahashi T, Yamashita S, Matsuzawa Y: Abdominal fat: standardized technique for measurement at CT. Radiology 1999, 211:283-286.
• [16]Miyato H, Kitayama J, Hidemura A, Ishigami H, Kaisaki S, Nagawa H: Vagus nerve preservation selectively restores visceral fat volume in patients with early gastric cancer who underwent gastrectomy. J Surg Res 2012, 173:60-67.
• [17]Yoon DY, Kim HK, Kim JA, Choi CS, Yun EJ, Chang SK, Lee YJ, Park CH: Changes in the abdominal fat distribution after gastrectomy: computed tomography assessment. ANZ J Surg 2007, 77:121-125.
• [18]Olbers T, Bjorkman S, Lindroos A, Maleckas A, Lonn L, Sjostrom L, Lonroth H: Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg 2006, 244:715-722.
• [19]Falko JM, Crockett SE, Cataland S, Mazzaferri EL: Gastric inhibitory polypeptide (GIP) stimulated by fat ingestion in man. J Clin Endocrinol Metab 1975, 41:260-265.
• [20]Miyawaki K, Yamada Y, Ban N, Ihara Y, Tsukiyama K, Zhou H, Fujimoto S, Oku A, Tsuda K, Toyokuni S, Hiai H, Mizunoya W, Fushiki T, Holst JJ, Makino M, Tashita A, Kobara Y, Tsubamoto Y, Jinnouchi T, Jomori T, Seino Y: Inhibition of gastric inhibitory polypeptide signaling prevents obesity. Nat Med 2002, 8:738-742.
• [21]Korner J, Bessler M, Inabnet W, Taveras C, Holst JJ: Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding. Surg Obes Relat Dis 2007, 3:597-601.
• [22]Jendle J, Nauck MA, Matthews DR, Frid A, Hermansen K, During M, Zdravkovic M, Strauss BJ, Garber AJ: Weight loss with liraglutide, a once-daily human glucagon-like peptide-1 analogue for type 2 diabetes treatment as monotherapy or added to metformin, is primarily as a result of a reduction in fat tissue. Diabetes Obes Metab 2009, 11:1163-1172.
• [23]Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, Kern B, von Fluee M, Beglinger C: Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg 2012, 22:740-748.
• [24]Takase M, Sumiyama Y, Nagao J: Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: digestion and absorption test with stable isotope 13C-labeled lipid compound. Gastric Cancer 2003, 6:134-141.
• [25]Fabbrini E, Tamboli RA, Magkos F, Marks-Shulman PA, Eckhauser AW, Richards WO, Klein S, Abumrad NN: Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology 2010, 139:448-455.
• [26]Dillard TH, Purnell JQ, Smith MD, Raum W, Hong D, Laut J, Patterson EJ: Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Surg Obes Relat Dis 2013, 9:269-275.