Koji Tanaka1, Shuji Takiguchi2, Isao Miyashiro3, Motohiro Hirao4, Kazuyoshi Yamamoto4, Hiroshi Imamura5, Masahiko Yano3, Masaki Mori1, Yuichiro Doki1. 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. 2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. Electronic address: stakiguti@gesurg.med.osaka-u.ac.jp. 3. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. 4. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 5. Department of Surgery, Sakai Municipal Hospital, Osaka, Japan.
Abstract
BACKGROUND: Visceral fat is one of the causes of metabolic syndrome. Among the various types of bariatric surgery, duodenal-jejunal bypass is one of the most common procedures. However, the effect of duodenal bypass on fat changes is not completely understood. We examined the effect of duodenal bypass on visceral fat changes by comparing Billroth I (BI) and roux-en Y (RY) reconstruction in distal gastrectomy. METHODS: This retrospective study used data from 221 patients registered for a prospective randomized trial that compared BI to RY in distal gastrectomy with lymphadenectomy to treat gastric cancer. With a software package, we first quantified the visceral fat area (VFA) on cross-sectional computed tomography scans obtained at the level of the umbilicus before and 1 year after surgery, and then determined the impact of duodenal bypass on visceral fat changes. RESULTS: Clinicopathological background data did not differ between BI and RY. Rates of BMI reduction for BI and RY also did not differ. The VFA reduction rate for RY (47.2 ± 25.5%) was greater than for BI (36.8 ± 34.2%, P = .0104). Adjuvant chemotherapy (chemotherapy versus no chemotherapy, P = .0136), type of reconstruction (BI versus RY, P < .0001), and pathologic stage (p stage I versus p stage II-IV, P = .0468) correlated significantly with postoperative visceral fat loss. Multivariate logistic regression analysis identified reconstruction (BI versus RY, P = .0078) as a significant determinant of visceral fat loss. CONCLUSION:Visceral fat loss after distal gastrectomy was greater for RY than for BI, and duodenal bypass may be associated with reduction of visceral fat.
RCT Entities:
BACKGROUND: Visceral fat is one of the causes of metabolic syndrome. Among the various types of bariatric surgery, duodenal-jejunal bypass is one of the most common procedures. However, the effect of duodenal bypass on fat changes is not completely understood. We examined the effect of duodenal bypass on visceral fat changes by comparing Billroth I (BI) and roux-en Y (RY) reconstruction in distal gastrectomy. METHODS: This retrospective study used data from 221 patients registered for a prospective randomized trial that compared BI to RY in distal gastrectomy with lymphadenectomy to treat gastric cancer. With a software package, we first quantified the visceral fat area (VFA) on cross-sectional computed tomography scans obtained at the level of the umbilicus before and 1 year after surgery, and then determined the impact of duodenal bypass on visceral fat changes. RESULTS: Clinicopathological background data did not differ between BI and RY. Rates of BMI reduction for BI and RY also did not differ. The VFA reduction rate for RY (47.2 ± 25.5%) was greater than for BI (36.8 ± 34.2%, P = .0104). Adjuvant chemotherapy (chemotherapy versus no chemotherapy, P = .0136), type of reconstruction (BI versus RY, P < .0001), and pathologic stage (p stage I versus p stage II-IV, P = .0468) correlated significantly with postoperative visceral fat loss. Multivariate logistic regression analysis identified reconstruction (BI versus RY, P = .0078) as a significant determinant of visceral fat loss. CONCLUSION:Visceral fat loss after distal gastrectomy was greater for RY than for BI, and duodenal bypass may be associated with reduction of visceral fat.