The impact of gastrectomy on diabetes and related conditions, coronary heart disease, stroke, cancer, and survival: follow-up from the Honolulu heart program

Rationale for the study Gastric surgery is coming into widespread use to treat obesity, but the effects of these operations for health in old age are not known. Here we examine the long term effects of partial gastrectomy which was used in the 20th century to treat peptic ulcers and shares features with some of today’s bariatric (weight loss) operations. We compare long-term outcomes in 347 men with a partial gastrectomy who were subjects in a prospective study of 8006 American Japanese men in Honolulu with their non-operated peers. Methods Subjects were age 45-68 at the baseline examination in 1965-68 and survivors were assessed for diabetes and insulin resistance 25 years later. Incidence of heart attacks and strokes was ascertained from hospital records and incidence of cancer was obtained from the Hawaii Tumor Registry. Mortality data were collected by the state health department. Results Mean weight for the men with a prior gastrectomy was 11 pounds less than for their peers, a difference that persisted throughout. A substantially larger proportion of the gastrectomy group smoked cigarettes. At enrollment, the gastrectomy men had lower serum cholesterol, triglycerides, glucose and blood pressure than the other men. These differences also persisted except for blood pressure which increased more over time in the gastrectomy men than in the others. At the 25 year exam, systolic blood pressure was significantly higher in the gastrectomy men. The gastrectomy men had a 50% lower incidence of diabetes and significantly less insulin resistance than their peers. There was no difference in the occurrence of coronary disease, but stroke incidence and mortality were both higher in the gastrectomy group. Mortality from smoking related causes (lung cancer and emphysema) were also increased. Stomach cancer was decreased by more than half after controlling for confounders. Conclusion The protection against diabetes is consistent with other reports and appears long-lasting and robust. “Remnant” stomach cancers that have been reported after gastrectomy were not found. The increase in blood pressure and stroke is worrisome and suggests the need for evaluation of this potential problem following the several bariatric surgical procedures now in widespread use.Ph.D.Includes bibliographical referencesby Isaias Noel Gendrano II