Impact of Abdominal Shape on Short-Term Surgical Outcome of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Abstract

LADG with D2 lymph node dissection can effectively achieve the lymph node dissection requirement of radical distal gastrectomy for patients with various abdominal shapes. It is worth noting that APD, TD, and SCF can impact on lymph node dissection of LADG in male patients. Nevertheless, in female patients, abdominal shape do not impact on lymph node dissection of LADG. Moreover, LADG with D2 lymph node dissection is proved to be safe for various abdominal shape in both genders, even for abdominal obese patients.

Role of obesity and abdominal shape morphometric features to predict postoperative complications and quality of lymph node dissection of gastrectomy for gastric cancer

“…Gender has been regarded as an important factor for different types of fat accumulation: visceral fat and subcutaneous fat. It has been thought that abdominal shape is sexually dimorphic, and men accumulate more visceral fat and women accumulate more subcutaneous fat [3,12]. However, considering VFA levels, there was no significant difference between male and female patients in the present study.…”

“…In previous studies, it has been shown that the retrieved number of lymph nodes were fewer in male patients with higher indexes of obesity or abdominal shape [2,3,11,21]. In Bickenbach's collective analysis of gastric cancer patients, increased BMI has been shown to be associated with less lymph node sampling [21].…”

“…Lee speculated that APD and intraabdominal fat volume are important factors for abdominal wall distensibility in men and the number of retrieved lymph nodes in female patients, respectively, The authors also thought that these factors cause major differences in postoperative morbidity and oncologic outcomes [2]. Wang et al [3] detected a significant association between BMI and other abdominal shape parameters and retrieved lymph nodes only in male patients after laparoscopic gastric surgery. Correlations between surgical outcomes and BMI and other parameters has been found only in male patients in Ojima's study [12].…”

“…With regard to the abdominal shape-related measures including APD, TD and DR-C, there have been many studies with controversial results focusing on the prediction of postoperative complications or retrieved lymph nodes after gastric cancer surgery [1-3, 11, 12, 14, 29]. The possible impact of these parameters on laparoscopic gastric cancer surgery has been studied more common than that of the open surgery [1,3,[11][12][13][14]27]. In Hiki's study, total fat, subcutaneous fat, VFA and the peritoneum celiac axis distance were shown to be only disruptive for estimated blood loss and numbers of retrieved lymph nodes.…”

“…It has been thought that obesity is a well-known independent risk factor for all-cause mortality [1]. Abdominal operations performed for gastrointestinal tract cancers are technically difficult with substantially increased risk of morbidity and mortality because of the accumulated visceral fat tissues in obese patients [1][2][3][4]. Although there have been many studies with regard to the possible relationship between obesity and surgical outcomes from Eastern population, there are a few studies to evaluate the exact impact of obesity on surgical complications and oncologic outcomes of gastric cancer from Western population in which their morphometric features are different from their Eastern counterparts [1,4,5].…”