# Impact of Ghrelin‐Depleting Gastrectomy on Long‐Term Endocrine and Metabolic Health With a Focus on Skeletal Muscle and Bone Mineral Content

## TL;DR

Gastrectomy that removes ghrelin-producing stomach regions leads to long-term loss of muscle and bone health in gastric cancer patients.

## Contribution

This study shows that preserving ghrelin-rich stomach areas during surgery helps maintain metabolic health, specifically skeletal muscle and bone mineral content.

## Key findings

- Ghrelin-depleted gastrectomy significantly reduces serum desacyl-ghrelin, skeletal muscle mass, and bone mineral content.
- IGF-1 levels are positively correlated with skeletal muscle mass but not significantly with bone mineral content.
- Preserving ghrelin-rich regions during surgery is linked to better long-term metabolic outcomes.

## Abstract

Advances in diagnostic and surgical techniques have improved survival rates for gastric cancer patients. However, gastrectomy involving ghrelin‐secreting regions of the upper gastric greater curvature can lead to long‐term endocrine and metabolic disturbances, including reductions in serum ghrelin and insulin‐like growth factor‐1 (IGF‐1), potentially contributing to skeletal muscle and bone mineral loss.

This prospective observational study included 35 gastric cancer patients who underwent gastrectomy between 2016 and 2018, with follow‐up for 3–5 years. Patients were categorized into ghrelin‐depleted (total or proximal gastrectomy) and ghrelin‐preserved (distal gastrectomy) groups. Serum desacyl‐ghrelin, IGF‐1, and insulin‐like growth factor‐binding protein‐3 (IGFBP‐3) levels were measured, and skeletal muscle mass and bone mineral content were assessed.

The ghrelin‐depleted group exhibited significantly lower serum desacyl‐ghrelin (56.9 ± 27.9 vs. 111.2 ± 54.8 fmol/mL, p = 0.0006), skeletal muscle mass (87.7% ± 2.1% vs. 95.1% ± 2.4%, p = 0.0229), and bone mineral content (90.9% ± 13.0% vs. 99.5% ± 6.3%, p = 0.0249). Additionally, IGF‐1 levels showed a significant positive correlation with skeletal muscle mass (r = 0.53, p = 0.020). While the correlation between IGF‐1 and bone mineral content did not reach statistical significance, a positive trend was observed (r = 0.44, p = 0.062).

Gastrectomy involving resection of ghrelin‐rich regions leads to long‐term reductions in serum desacyl‐ghrelin levels, adversely affecting skeletal muscle mass and bone mineral content. These findings highlight the importance of considering the endocrine consequences when selecting surgical procedures.

This study investigates the long‐term endocrine and metabolic consequences of ghrelin‐depleted gastrectomy, with a focus on skeletal muscle mass and bone mineral content. Sustained reductions in serum desacyl‐ghrelin were linked to lower IGF‐1 levels, resulting in significant loss of muscle and bone. These findings underscore the importance of preserving ghrelin‐rich regions during gastric cancer surgery to maintain long‐term metabolic health.