Surgical TreAtment for Obesity Related Disease and Onco-Metabolic Surgery

This is a prospective, multi-center, randomized controlled trial to compare Billroth II reconstruction versus conventional Roux-en-Y reconstruction versus long limb Roux-en-Y reconstruction for glycemic control in patients with concurrent type 2 diabetes and gastric cancer.

Inclusion Criteria: * Distal gastric adenocarcinoma diagnosed pathologically under preoperative endoscopic biopsy, and clinical stage I-II * Body mass index ≥ 23 kg/m2 * Type 2 diabetes and HbA1c ≥ 6.5% Exclusion Criteria: * Insulin usage for glycemic control at the time of screening evaluation * Prior gastrointestinal surgery including splenectomy, hepatobiliary and pancreatic surgery (except hemorrhoidectomy, herniorrhaphy, and appendectomy) * Abdominal, thoracic, pelvic and/or obstetric-gynecologic surgery within 3 months * Cardiovascular conditions including significant known CAD, uncompensated congestive heart failure, history of stroke, or uncontrolled hypertension. Subjects with CAD that have been successfully treated with CABG or PCI, and have no evidence of active ischemia are eligible * Kidney disease including renovascular hypertension, renal artery stenosis, or end-stage renal disease * Chronic liver disease including liver cirrhosis, alpha-1 antitrypsin deficiency * Gastrointestinal disorders including inflammatory bowel disease (Crohn's disease or ulcerative colitis) or any malabsorptive disorders * Psychiatric disorders including dementia, active psychosis, history of suicide attempts, alcohol or drug abuse within 12 months * Severe pulmonary disease defined as FEV1 \