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Ki Hyun Kim 2 Articles
Hepatic steatosis changes after early gastric cancer surgery
Ki Hyun Kim, Soyoung Ock, Dohyung Lee, Yoonhong Kim, Jihoon Jo, Kyungwon Seo, Kiyoung Yoon, Sukyoung Kwon, Youngsik Choi, Bukyung Kim
Kosin Med J. 2022;37(1):68-74.   Published online March 28, 2022
DOI: https://doi.org/10.7180/kmj.22.008
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Background
Nonalcoholic fatty liver disease dramatically improves after bariatric surgery, primarily due to improvements in hepatic insulin sensitivity. Since the procedure for gastric cancer surgery is very similar to that for bariatric surgery, we investigated changes in fatty liver following gastrectomy for gastric cancer according to the type of surgery.
Methods
We evaluated hepatic steatosis in 212 early gastric cancer patients using Hounsfield units (HUs) on non-contrast computed tomography preoperatively and 6, 12, and 24 months after surgery. We compared the preoperative and postoperative liver-to-spleen HU ratio according to the type of surgery: Billroth I, Billroth II, and total gastrectomy with Roux-en-Y reconstruction.
Results
The initial results (liver/spleen HUs and the liver-to-spleen HU ratio) did not significantly differ according to surgical group. After surgery, only patients who underwent total gastrectomy with Roux-en-Y exhibited significant changes in the liver-to-spleen HU ratio at 6 months. In 26 patients who had higher initial HU levels of the spleen than the liver, the liver-to-spleen HU ratio significantly increased from 0.836 to 1.115 at 6 months, 1.109 at 12 months, and 1.102 at 24 months (P<0.01).
Conclusion
Significant changes in hepatic steatosis were found in even normal patients (with higher liver than spleen HU values) who underwent total gastrectomy with Roux-en-Y. Patients who initially had fatty liver also showed a significant increase in the liver-to-spleen HU ratio. These results suggest that total gastrectomy with Roux-en-Y reconstruction can have a positive effect on the improvement of hepatic steatosis.
Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes
Ki Hyun Kim, Yoon Hong Kim, Kyung Won Seo, Ki Young Yoon, Yeon Myeong Shin, Young Sik Choi, Bu Kyung Kim
Kosin Med J. 2021;36(1):25-33.   Published online June 30, 2021
DOI: https://doi.org/10.7180/kmj.2021.36.1.25
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer.

Methods

A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC).

Results

The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery.

Conclusions

Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.


KMJ : Kosin Medical Journal