An Elevated Body Mass Index Does Not Reduce Survival After Esophagectomy for Cancer

Abstract

Background Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer. Methods Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25–29), and normal-weight (BMI 20–24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan–Meier method, and differences were analyzed by log rank method. Results The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years, P = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%, P = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%, P = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%, P = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%, P = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%, P = 0.01 and 48, 44, 34%, P = 0.01). Conclusions In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer.

Does Obesity Affect Outcomes in Patients Undergoing Esophagectomy for Cancer? A Meta‐analysis

“…All five studies reported on incidence of wound infections [30][31][32][33][34], and two studies reported on deep vein thrombosis (DVT) [31,33]. There was no significant difference in the …”

“…The characteristics of the five studies [30][31][32][33][34] used in this meta-analysis and their outcomes are summarized in Table 1. All five studies were retrospective cohort studies comparing the impact of BMI on outcomes after esophagectomy, with three of these studies specifically comparing outcomes between obese and non-obese patients after esophageal resection [30,32,34].…”

“…Patients with both adenocarcinoma (1,066) and squamous cell carcinoma (184) were included in the study. In total, three studies included patients who underwent transhiatal or transthoracic esophageal resection [32][33][34], one study included patients who exclusively underwent minimally invasive resection [30], and one study included patients who underwent all three different techniques for esophageal resection [31]. As per recommendations by WHO, a BMI of 30 kg/m 2 was selected as the cut-off value to divide patients into obese (BMI C 30 kg/m 2 ) and non-obese (BMI \ 30 kg/m 2 ) groups.…”

“…Two studies assessed the oncological quality of excised specimens to test for R0 resection (complete resection with no microscopic residual tumour) [31,34]. All five studies reported respiratory complications [30][31][32][33][34] after esophageal resection.…”

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] .…”