Abdominal Shape of Gastric Cancer Patients Influences Short-Term Surgical Outcomes

Lee, Jun Ho; Paik, Yong Hae; Lee, Jong-Seok; Ryu, Keun Won; Kim, Chan Gyoo; Park, Sook Ryeon; Kim, Young Woo; Kook, Myeong Cherl; Nam, Byung Ho; Bae, Jae Moon

doi:10.1245/s10434-006-9235-1

Cited by 69 publications

(73 citation statements)

References 17 publications

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“…However, the mean BMI of our patients (23.2 kg/m 2 ) is comparable with the mean BMI of the patients receiving open gastrectomy in other Korean studies (23.4-23.9 kg/m 2 ) [7,19]. Furthermore, it also is comparable with the average BMI (23.2 kg/ m 2 ) in a prospective cohort study examining 1,213,829 Koreans [27].…”

Section: Discussionsupporting

confidence: 85%

“…This feature has already been stressed in several articles evaluating patients who had undergone open or laparoscopic gastrectomy [7,10]. This phenomenon may be related to the different fat patterns in men and women.…”

Section: Discussionmentioning

confidence: 83%

“…For example, in the Japan Clinical Oncology Group (JCOG) 9501 study, which compared D2 and D2 plus para-aortic LN dissections among gastric cancer patients, only obesity and age were identified as significant patient-related factors associated with major surgical complications [6,18]. Many largescale studies have repeatedly demonstrated that obesity influences surgical outcomes after gastric cancer surgery [7,[19][20][21]. Conversely, studies focusing on LAG have shown that obesity does not increase surgical morbidity [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

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The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Lee

Kim

et al. 2009

Surg Endosc

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Background Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. Methods The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI C 25 kg/m 2 ; n = 432) and low BMI (BMI \25 kg/ m 2 ; n = 1,053) groups, and their clinical outcomes were compared. Results The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p \ 0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. Conclusions High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Lee

Kim

et al. 2009

Surg Endosc

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“…According to their results, not only anastomosis, such as gastroduodenostomy or gastrojejunostomy, was possible, but also esophagojejunostomy, which should be performed in the deep and narrow space of the abdominal cavity, was feasible, such as urethral anastomosis in radical prostatectomy or valve replacement in cardiac surgery, owing to three-dimensional visualization, wristed instruments with seven degrees of surgical freedom, and tremor filtration [14,17,[19][20][21]59] . This technique seems to maximize the advantage for patients with a high BMI, because the length of minilaparotomy for extracorporeal anastomosis is not "mini" for obese patients [60][61][62][63][64][65] . This potential benefit of robotic surgery maintains the merits of laparoscopic surgery compared to open surgery, in terms of postoperative pain and cosmesis [48,49,66] .…”

Section: Challenges In the Advanced Fieldmentioning

confidence: 99%

Current status of robot-assisted gastric surgery

Baek

Lee²,

Kim³

2011

WJGO

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In an effort to minimize the limitations of laparoscopy, a robotic surgery system was introduced, but its role for gastric cancer is still unclear. The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects. Although the current study was limited by its small number of patients and retrospective nature, robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons. Most studies have reported satisfactory results for postoperative short-term coutcomes, such as: postoperative oral feeding, gas out, hospital stay and complications, compared with laparoscopic surgery; the difference is a longer operation time. However, robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery; after the accumulation of several cases, robotic surgery could be expected to result in a similar operation time. Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy. Moreover, "total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique. In conclusion, robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer, provided that long-term oncologic outcomes can be confirmed.

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“…Of these, the preoperative prognostic nutritional index (PNI) as a reflection of the immunological and nutritional condition of the patients has been associated with the outcomes of patients who undergo gastrectomy for a number of stages of GC (10,11,16,17). Although the association between body mass index (BMI) and postoperative complications has been investigated (18)(19)(20)(21)(22), the association between BMI and long-term survival subsequent to curative gastrectomy remains unclear (23)(24)(25)(26)(27)(28) In the present study, the dose-response effects of S-1 ACT on survival in patients who received gastrectomy for GC were clarified, and other clinical factors that affected their survival were analyzed, including BMI and PNI as nutritional parameters.…”

Section: Introductionmentioning

confidence: 99%

Outcome predictors for patients with stage II/III gastric cancer who undergo gastrectomy and S-1 adjuvant chemotherapy

et al. 2017

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Abstract. Predictors of survival in patients with stage II/III gastric cancer (GC) who received tegafur/gimeracil/oteracil (S-1) adjuvant chemotherapy (ACT) subsequent to gastrectomy were examined. Additionally, the association between dose intensity of S-1 and survival rate was investigated. A total of 62 patients with stage II/III gastric cancer were retrospectively evaluated, each of whom had received a curative D2 gastrectomy and S-1 ACT. The relative performance (RP; administered/planned S-1 doses x100%), body mass index (BMI), prognostic nutritional index (PNI) and body weight (BW) were calculated, and the association of survival with these factors and other clinicopathological parameters was examined. The 1-year treatment continuation rate for S-1 was 94.2%, excluding patients who experienced cancer recurrences during their ACT year. The initial S-1 reduction rate was 38.7%. Patients with stage II/IIIA disease exhibited significantly improved 5-year overall survival rates compared with patients with stage IIIB GC, 81.6/73.7 vs. 33.8% (P<0.01). No association between RP and survival was observed. BMI, BW and PNI were significantly decreased following surgery compared with preoperative states. In the univariate analysis, postoperative BW loss (BMI loss), pathological stage and >7 lymph node metastases were significantly associated with outcome (P<0.05); in the multivariate analysis, postoperative BW loss >10.6% and pathological stages were independent prognostic factors for survival. Continuing S-1 ACT for the full year exhibited a greater effect on survival compared with dosage. Early postoperative nutritional deterioration may decrease the survival rates in these patients.

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Abdominal Shape of Gastric Cancer Patients Influences Short-Term Surgical Outcomes

Abstract: We conclude that obesity and abdominal shape of gastric cancer patients both influence the short-term surgical outcomes of subtotal gastrectomy with D2 lymph node dissection.

Cited by 69 publications

References 17 publications

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Current status of robot-assisted gastric surgery

Outcome predictors for patients with stage II/III gastric cancer who undergo gastrectomy and S-1 adjuvant chemotherapy

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