Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial
Background This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer. Methods We randomly assigned gastric cancer patients with t...
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| Veröffentlicht in: | World journal of surgery 2011-01, Vol.35 (1), p.85-92 |
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| creator | Cao, Shou-Gen Ren, Jian-An Shen, Bo Chen, Dong Zhou, Yan-Bing Li, Jie-Shou |
| description | Background
This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.
Methods
We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.
Results
Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l,
P
|
| doi_str_mv | 10.1007/s00268-010-0797-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_821201268</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2219195781</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5166-9419b503de7590329d465a161faa1f34126cdb4890f8b37e0c9b19f0438c82203</originalsourceid><addsrcrecordid>eNqFkc1u1DAUhSMEotPCA7BBFhJiFbi2E8dhV6a0DKoEgiksIye5GVw59mAnrcJ78L44ykAlJMTKx9J37t9JkicUXlKA4lUAYEKmQCGFoizS_F6yohlnKeOM309WwEUWNeVHyXEI1wC0ECAeJkcMZCE5y1bJz40d0AZ9g-QL-jAGsnb2Bu2gnVWGbGwYjbZk-w292k9kltMeCSNnWtU4YCAf1aAjH8iVbdHvnLY7csbIhQqDx2Zw_UQ655e_bsha2Qb9a3JKPinbul7_wHbuOXhnTJRbr5V5lDzolAn4-PCeJFfnb7frd-nlh4vN-vQybXIqRFpmtKxz4C0WeQmclW0mckUF7ZSiHc8oE01bZ7KETta8QGjKmpYdZFw2kjHgJ8mLpe7eu-8jhqHqdWjQGGXRjaGSjDKIVWQkn_1FXrvRxxNFiJYiE0XBIkQXqPEuBI9dtfe6V36qKFRzYtWSWBUTq-bEqjx6nh4Kj3WP7R_H74gi8PwAqNAo0_l4QB3uOC5lxuQ8Yblwt9rg9P_O1df3n9-cQ864iF62eEO02R36u-3-PfkvZU6-Uw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>819646772</pqid></control><display><type>article</type><title>Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>SpringerLink Journals - AutoHoldings</source><creator>Cao, Shou-Gen ; Ren, Jian-An ; Shen, Bo ; Chen, Dong ; Zhou, Yan-Bing ; Li, Jie-Shou</creator><creatorcontrib>Cao, Shou-Gen ; Ren, Jian-An ; Shen, Bo ; Chen, Dong ; Zhou, Yan-Bing ; Li, Jie-Shou</creatorcontrib><description>Background
This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.
Methods
We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.
Results
Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l,
P
< 0.001). Hypoglycemia occurred in 6 patients (6.5%) in the IG (
P
= 0.029) versus in 1 patient (1.1%) in the CG. Hospital mortality did not differ significantly between two groups (4.3% vs. 5.7%,
P
= 0.742). However, IIT significantly reduced morbidity (from 18.4 to 7.6%,
P
= 0.031). Also, IIT shortened the days to suture removal, postoperative hospital stay, and postoperative duration of antibiotic use. The HOMA-IR score was lower at all time points in IG. Moreover, IIT increased the postoperative HLA-DR expression on monocytes on postoperative days 3 and 5.
Conclusions
IIT significantly reduced short-term morbidity but not mortality among type 2 DM patients who underwent D2 gastrectomy for gastric cancer. Furthermore, a possible mechanism of suppression of the insulin resistance and improvement of HLA-DR expression may partially explain the benefits of IIT.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-010-0797-5</identifier><identifier>PMID: 20878324</identifier><identifier>CODEN: WJSUDI</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Antibiotic Prophylaxis ; Biological and medical sciences ; Blood Glucose - analysis ; Cardiac Surgery ; Chi-Square Distribution ; Conventional Group ; Diabetes Mellitus Patient ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Gastrectomy - methods ; Gastric Cancer ; General aspects ; General Surgery ; HLA-DR Antigens - blood ; Humans ; Hypoglycemia ; Hypoglycemic Agents - administration & dosage ; Insulin - administration & dosage ; Intensive Insulin Therapy ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Statistics, Nonparametric ; Stomach Neoplasms - surgery ; Stomach, duodenum, intestine, rectum, anus ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Thoracic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>World journal of surgery, 2011-01, Vol.35 (1), p.85-92</ispartof><rights>Société Internationale de Chirurgie 2010</rights><rights>2011 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>2015 INIST-CNRS</rights><rights>Société Internationale de Chirurgie 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5166-9419b503de7590329d465a161faa1f34126cdb4890f8b37e0c9b19f0438c82203</citedby><cites>FETCH-LOGICAL-c5166-9419b503de7590329d465a161faa1f34126cdb4890f8b37e0c9b19f0438c82203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-010-0797-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-010-0797-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,41488,42557,45574,45575,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23884288$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20878324$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cao, Shou-Gen</creatorcontrib><creatorcontrib>Ren, Jian-An</creatorcontrib><creatorcontrib>Shen, Bo</creatorcontrib><creatorcontrib>Chen, Dong</creatorcontrib><creatorcontrib>Zhou, Yan-Bing</creatorcontrib><creatorcontrib>Li, Jie-Shou</creatorcontrib><title>Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.
Methods
We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.
Results
Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l,
P
< 0.001). Hypoglycemia occurred in 6 patients (6.5%) in the IG (
P
= 0.029) versus in 1 patient (1.1%) in the CG. Hospital mortality did not differ significantly between two groups (4.3% vs. 5.7%,
P
= 0.742). However, IIT significantly reduced morbidity (from 18.4 to 7.6%,
P
= 0.031). Also, IIT shortened the days to suture removal, postoperative hospital stay, and postoperative duration of antibiotic use. The HOMA-IR score was lower at all time points in IG. Moreover, IIT increased the postoperative HLA-DR expression on monocytes on postoperative days 3 and 5.
Conclusions
IIT significantly reduced short-term morbidity but not mortality among type 2 DM patients who underwent D2 gastrectomy for gastric cancer. Furthermore, a possible mechanism of suppression of the insulin resistance and improvement of HLA-DR expression may partially explain the benefits of IIT.</description><subject>Abdominal Surgery</subject><subject>Antibiotic Prophylaxis</subject><subject>Biological and medical sciences</subject><subject>Blood Glucose - analysis</subject><subject>Cardiac Surgery</subject><subject>Chi-Square Distribution</subject><subject>Conventional Group</subject><subject>Diabetes Mellitus Patient</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Gastrectomy - methods</subject><subject>Gastric Cancer</subject><subject>General aspects</subject><subject>General Surgery</subject><subject>HLA-DR Antigens - blood</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Insulin - administration & dosage</subject><subject>Intensive Insulin Therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Statistics, Nonparametric</subject><subject>Stomach Neoplasms - surgery</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkc1u1DAUhSMEotPCA7BBFhJiFbi2E8dhV6a0DKoEgiksIye5GVw59mAnrcJ78L44ykAlJMTKx9J37t9JkicUXlKA4lUAYEKmQCGFoizS_F6yohlnKeOM309WwEUWNeVHyXEI1wC0ECAeJkcMZCE5y1bJz40d0AZ9g-QL-jAGsnb2Bu2gnVWGbGwYjbZk-w292k9kltMeCSNnWtU4YCAf1aAjH8iVbdHvnLY7csbIhQqDx2Zw_UQ655e_bsha2Qb9a3JKPinbul7_wHbuOXhnTJRbr5V5lDzolAn4-PCeJFfnb7frd-nlh4vN-vQybXIqRFpmtKxz4C0WeQmclW0mckUF7ZSiHc8oE01bZ7KETta8QGjKmpYdZFw2kjHgJ8mLpe7eu-8jhqHqdWjQGGXRjaGSjDKIVWQkn_1FXrvRxxNFiJYiE0XBIkQXqPEuBI9dtfe6V36qKFRzYtWSWBUTq-bEqjx6nh4Kj3WP7R_H74gi8PwAqNAo0_l4QB3uOC5lxuQ8Yblwt9rg9P_O1df3n9-cQ864iF62eEO02R36u-3-PfkvZU6-Uw</recordid><startdate>201101</startdate><enddate>201101</enddate><creator>Cao, Shou-Gen</creator><creator>Ren, Jian-An</creator><creator>Shen, Bo</creator><creator>Chen, Dong</creator><creator>Zhou, Yan-Bing</creator><creator>Li, Jie-Shou</creator><general>Springer-Verlag</general><general>Springer‐Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201101</creationdate><title>Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial</title><author>Cao, Shou-Gen ; Ren, Jian-An ; Shen, Bo ; Chen, Dong ; Zhou, Yan-Bing ; Li, Jie-Shou</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5166-9419b503de7590329d465a161faa1f34126cdb4890f8b37e0c9b19f0438c82203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Abdominal Surgery</topic><topic>Antibiotic Prophylaxis</topic><topic>Biological and medical sciences</topic><topic>Blood Glucose - analysis</topic><topic>Cardiac Surgery</topic><topic>Chi-Square Distribution</topic><topic>Conventional Group</topic><topic>Diabetes Mellitus Patient</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Gastrectomy - methods</topic><topic>Gastric Cancer</topic><topic>General aspects</topic><topic>General Surgery</topic><topic>HLA-DR Antigens - blood</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Insulin - administration & dosage</topic><topic>Intensive Insulin Therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Statistics, Nonparametric</topic><topic>Stomach Neoplasms - surgery</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cao, Shou-Gen</creatorcontrib><creatorcontrib>Ren, Jian-An</creatorcontrib><creatorcontrib>Shen, Bo</creatorcontrib><creatorcontrib>Chen, Dong</creatorcontrib><creatorcontrib>Zhou, Yan-Bing</creatorcontrib><creatorcontrib>Li, Jie-Shou</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cao, Shou-Gen</au><au>Ren, Jian-An</au><au>Shen, Bo</au><au>Chen, Dong</au><au>Zhou, Yan-Bing</au><au>Li, Jie-Shou</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2011-01</date><risdate>2011</risdate><volume>35</volume><issue>1</issue><spage>85</spage><epage>92</epage><pages>85-92</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><coden>WJSUDI</coden><abstract>Background
This study was to compare the effect of intensive insulin therapy (IIT) to conventional insulin therapy (CIT) on postoperative outcomes among type 2 diabetes mellitus (DM) patients who underwent D2 gastrectomy for gastric cancer.
Methods
We randomly assigned gastric cancer patients with type 2 DM who underwent radical gastrectomy to receive IIT (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/l) with insulin infusion or CIT (maintenance of blood glucose at a level between 10 and 11.1 mmol/l) during the postoperative period.
Results
Of the 179 eligible patients, 92 patients were assigned to receive IIT and 87 patients to receive CIT. Mean blood glucose concentrations were lower in the intensive group (IG) than in the conventional group (CG) (5.5 ± 0.8 vs. 9.9 ± 1.0 mmol/l,
P
< 0.001). Hypoglycemia occurred in 6 patients (6.5%) in the IG (
P
= 0.029) versus in 1 patient (1.1%) in the CG. Hospital mortality did not differ significantly between two groups (4.3% vs. 5.7%,
P
= 0.742). However, IIT significantly reduced morbidity (from 18.4 to 7.6%,
P
= 0.031). Also, IIT shortened the days to suture removal, postoperative hospital stay, and postoperative duration of antibiotic use. The HOMA-IR score was lower at all time points in IG. Moreover, IIT increased the postoperative HLA-DR expression on monocytes on postoperative days 3 and 5.
Conclusions
IIT significantly reduced short-term morbidity but not mortality among type 2 DM patients who underwent D2 gastrectomy for gastric cancer. Furthermore, a possible mechanism of suppression of the insulin resistance and improvement of HLA-DR expression may partially explain the benefits of IIT.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>20878324</pmid><doi>10.1007/s00268-010-0797-5</doi><tpages>8</tpages></addata></record> |
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| ispartof | World journal of surgery, 2011-01, Vol.35 (1), p.85-92 |
| issn | 0364-2313 1432-2323 |
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| subjects | Abdominal Surgery Antibiotic Prophylaxis Biological and medical sciences Blood Glucose - analysis Cardiac Surgery Chi-Square Distribution Conventional Group Diabetes Mellitus Patient Diabetes Mellitus, Type 2 - drug therapy Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Gastrectomy - methods Gastric Cancer General aspects General Surgery HLA-DR Antigens - blood Humans Hypoglycemia Hypoglycemic Agents - administration & dosage Insulin - administration & dosage Intensive Insulin Therapy Male Medical sciences Medicine Medicine & Public Health Middle Aged Statistics, Nonparametric Stomach Neoplasms - surgery Stomach, duodenum, intestine, rectum, anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Thoracic Surgery Treatment Outcome Vascular Surgery |
| title | Intensive Versus Conventional Insulin Therapy in Type 2 Diabetes Patients Undergoing D2 Gastrectomy for Gastric Cancer: A Randomized Controlled Trial |
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