A High Body Mass Index in Esophageal Cancer Patients Does Not Influence Postoperative Outcome or Long-Term Survival

Abstract

BackgroundThe body mass index (BMI) in the general population has increased over the past decades. A high BMI is a known risk factor for the development of esophageal adenocarcinoma. Several studies on the influence of a high BMI on the postoperative course and survival after esophagectomy have shown contradictory results. The aim of the present study was to determine the influence of a high BMI on postoperative complications and survival among a large cohort of esophageal cancer patients.MethodsPatients who underwent an esophagectomy between 1993 and 2010 were divided into three groups according to their BMI: normal weight (<25 kg/m2), overweight (25–30 kg/m2) or obese (≥30 kg/m2). Severity of complications was scored according to the Dindo classification, which was divided into three categories: no complications, minor to moderate complications, and severe complications. Long-term survival was determined according to the Kaplan–Meier method.ResultsA total of 736 esophagectomy patients were divided into three groups: normal weight (n = 352), overweight (n = 308), and obese (n = 72). Complications rates were similar for all groups (65–72%, P = 0.241). The incidence of anastomotic leakage was higher among obese patients compared to the other groups (20% vs. 10–12% respectively, P = 0.019), but there was no significant difference between the three groups regarding the severity of complications according to the Dindo classification (P = 0.660) or in 5-year survival rates (P = 0.517).ConclusionsA high BMI is not associated with an increased incidence or severity of complications after esophagectomy; however, anastomotic leakage occurred more frequently in obese patients. Five-year survival rates were not influenced by the preoperative BMI. A high BMI is therefore ought not be an exclusion criterion for esophagectomy.

Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review

“…17 A more recent study from Europe found that BMI >25 kg/m 2 was not associated with worse outcomes in 215 patients undergoing oesophagectomy for cancer; specifically, there were no differences in operative times (median 280 min in both normal or high BMI), morbidity (49% vs 53%, p=0.4), mortality (8.3% vs 3.4%, p=0.1) and median number of harvested lymph node (14 vs 11, p=0.054). 18 Two recent studies by Blom et al 19 and Grotenhius et al 20 have both demonstrated that patients with elevated BMI do not experience an increase in operative outcomes or oncological outcomes. However, Blom and colleagues did demonstrate an increase in anastomotic leaks in the obese population, a finding which we did not corroborate.…”

Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study

“…However, several recent studies in esophageal cancer patients all demonstrate that the total lymph node yield is not related to BMI. [31][32][33] These findings could potentially provide some indirect evidence that the meso-esophageal tissue volume also might not be related to the BMI.…”

High Body Mass Index Worsens Survival in Patients with Esophageal Squamous Cell Carcinoma after Esophagectomy

“…The main reasons for these conflicting reports include the different BMI cut-off values used across the different studies and the presence of confounding factors such as gender, age, comorbidities, histological type, neoadjuvant therapy, and smoking status [15][16][17] . The incidence of adenocarcinoma was higher in overweight and obese patients than that in normal weight patients [15,16] , and a significantly smaller percentage of obese patients received neoadjuvant chemotherapy compared with to the percentage of overweight and normal weight patients [16] . The prognostic impact of BMI stratified by smoking status was determined in patients with EAC; obesity in patients who had never smoked was independently associated with a 2-fold worsening of long-term survival after surgery [17] .…”