Impact of Body Mass Index on Surgical Outcomes in Radical Total Gastrectomy
ABSTRACT In this study, the authors evaluated the impact of body mass index (BMI) on surgical outcomes in patients undergoing total gastrectomy for upper third early gastric cancer.
Sixty-one consecutive patients with upper third early gastric cancer that underwent radical total gastrectomy from May 2009 to December 2009 were included in this prospective cohort study. Patients were stratified by BMI (in accordance with the WHO guidelines) into a normal group (18.5-24.9kg/m2), and an overweight group (≥25.0kg/m2). These two groups were compared with respect to stomach specimen weight (g), operative time (min), number of lymph nodes harvested, length of postoperative hospital stay (day), and postoperative complication rate (%).
Thirty-seven (61%) patients had a normal weight and 24 (39%) were overweight. According to multivariate analysis, the only factor correlated with BMI was the weight of stomach extirpated en bloc with omentum, and the weight of stomach extirpated en bloc with omentum was also significantly correlated with operative time. However, BMI was not found to be significantly correlated with postoperative complications.
This study suggested that an elevated BMI was significantly associated with increased weight of stomach extirpated en bloc with omentum, which was found to elongate operative times.
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ABSTRACT: Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results. Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25-30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival. Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren's histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male gender (P < 0.05), diabetes (P < 0.001), and serum blood proteins (P < 0.01). A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups. Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.Gastroenterology Research and Practice 02/2015; 2015:810134. DOI:10.1155/2015/810134 · 1.50 Impact Factor
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ABSTRACT: Overweight was regarded as one of the risk factors for poor outcome after gastrectomy, but its influence on the surgical and postoperative outcomes of gastrectomy was unclear. Comprehensive searches were conducted to include cohort studies which evaluated the influence of overweight on the surgical and postoperative outcomes of gastrectomy. Data was analyzed by RevMan 5.0. Twenty-five cohort studies (18 518 patients) were included. Overweight patients were associated with longer operation time (mean difference 20.88, 95% confidence interval 14.07, 27.69), more intraoperative blood loss (mean difference 35.45, 95% confidence interval 9.24, 61.67), and less retrieved lymph nodes (mean difference -2.17, 95% confidence interval -3.51, -0.83) than normal patients undergoing laparoscopy-assisted gastrectomy. And overweight patients were associated with longer operation time (mean difference 26.31, 95% confidence interval 21.92, 30.70), more intraoperative blood loss (mean difference 130.02, 95% confidence interval 75.49, 184.55), less retrieved lymph nodes (mean difference -3.18, 95% confidence interval -4.74, -1.61), longer postoperative hospital stay (mean difference 2.37, 95% confidence interval 0.03, 4.70) and more postoperative complications (risk ratio 1.53, 95% confidence interval 1.29, 1.80) than normal patients in open gastrectomy. Overweight might affect the clinical results of both laparoscopy-assisted and open gastrectomy, especially for open gastrectomy.Japanese Journal of Clinical Oncology 04/2014; 44(5). DOI:10.1093/jjco/hyu031 · 1.75 Impact Factor
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ABSTRACT: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m(2)] or overweight (BMI ≥ 25 kg/m(2)). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software. This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m(2); 4897 with BMI ≥ 25 kg/m(2)). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay. This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.World Journal of Gastroenterology 07/2013; 19(28):4596-606. DOI:10.3748/wjg.v19.i27.4596 · 2.43 Impact Factor