Background: The aim of the present study was to determine the correlation between obesity, serum levels of leptin and proximal gastric cancer. Methods: Sixty-four gastric cancer patients operated on with curative intent were included in the study. We determined the correlation between the preoperative serum levels of leptin and the tumor`s location. Results: Serum leptin levels were correlated significantly with the proximal third location (p = 0.04), gastric outlet obstructing tumors (p < 0.0001), CRP levels (p = 0.03) and BMI (p < 0.0001). Patients with high serum levels of leptin had significantly more intestinal types of gastric cancer (p = 0.033) and better differentiation compared to patients with low serum leptin levels (p = 0.009). The linear regression model determined the proximal tumor location (beta: 0.467; p = 0.045), BMI (beta: 0.657; p = 0.001), high preoperative serum albumin (beta: 0.563; p = 0.016) and the presence of pyloric stenosis (beta: 0.525; p = 0.006) as related significantly to serum leptin levels. The Cox proportional hazard model identified age (HR: 0.003; 95%CI: 0-0.794; p = 0.041), preoperative serum levels of leptin (HR: 0.125; 95%CI: 0.018-0.887; p = 0.037) and the number of extracted LNs (HR: 0.001; 95%CI: 0-0.677; p = 0.038) as independent prognostic factors. Conclusions: Serum levels of leptin were significantly elevated in patients with proximal gastric cancer, suggesting that the leptin`s effect might be due to its systemic secretion. This might explain the higher incidence of proximal gastric cancer in obese patients. Elevated serum leptin levels were an independent prognostic factor.

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Background In the present paper, we intend to present the shot- and long-term results of omentum-preserving laparoscopic gastric cancer resections with D2 lymphadenectomy in 100 consecutive patients with stages 0-IV and perioperative chemotherapy. Methods The study's primary objectives were the perioperative results, the length of postoperative stay, and the 5-year overall and 5-year disease-specific survival. Results The mean age was 69 ± 11 years; the mean BMI was 26 ± 3 kg/m2. The tumors were primarily located in the middle and distal third of the stomach; 12% were actively bleeding or causing obstruction, necessitating an emergency operation. Perioperative chemotherapy was administered in 46% of the patients. Most patients received a total gastrectomy (52%), and 45% received a distal subtotal gastrectomy. The conversion rate was 16%. Perioperative complications occurred in 20%; the perioperative mortality was 1%. The median hospital stay was eight days. The most common UICC stage was Ia, followed by IIIb. Early gastric cancer was present only in 29% of patients. The 5-year overall and disease-specific survivals were 57.5% and 72.6%, respectively. Conclusion The results from this single high-volume center confirm the safety of laparoscopic omentum-preserving gastrectomy with D2 lymphadenectomy in patients with advanced gastric cancer. The referral of gastric cancer patients to dedicated high-volume centers with specialized laparoscopic surgical teams might lead to similar high-quality results presented in Eastern trials.