Impact of Reconstruction Type and Pancreatic Atrophy on Glycemic Variability After Distal Gastrectomy

Pancreatic atrophy commonly develops after gastrectomy and may contribute to postoperative metabolic disorders. However, the relationship between pancreatic volume (PV) reduction and glycemic variability (GV) remains unclear. This study examined the association between pancreatic atrophy and glucose regulation following distal gastrectomy (DG).

Fifty-three patients who underwent DG for gastric cancer (2017-2021) were analyzed. PV was measured using contrast-enhanced computed tomography before and at one and two years postoperatively. Continuous glucose monitoring was performed one year after surgery. Patients were classified into mild or severe atrophy groups based on median PV ratio for Billroth-I (B-I) or Roux-en-Y (R-Y) reconstruction.

The R-Y group had a lower PV ratio than the B-I group. In the R-Y group, patients with mild atrophy had higher GV (coefficient of variation 0.43 vs. 0.33, p=0.028) and longer hyperglycemia (%time >180 mg/dl: 7.1% vs. 2.5%, p=0.025) than patients with severe atrophy. In the B-I group, patients with severe pancreatic atrophy experienced significantly greater body weight loss than those with mild atrophy (-11% vs. -7.5%, p=0.026).

R-Y reconstruction caused greater PV reduction than B-I and modulated postoperative glycemic variability through residual pancreatic function.