Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over‐D1” Lymphadenectomy for Gastric Cancer

Pata, Giacomo; Solaini, Leonardo; Roncali, Stefano; Pasini, M; Ragni, Fulvio

doi:10.1007/s00268-013-1942-8

Cited by 27 publications

(28 citation statements)

References 59 publications

(85 reference statements)

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“…This is in accordance with our own data, although perioperative costs have not been specifically analyzed; however, our study showed a significantly longer length of hospital stay for obese patients, resulting from higher postoperative morbidity rates, and thus, we assume higher postoperative costs in the obese patient group. Our data is further supported by a study on the impact of obesity on surgical and oncologic outcomes by Pata et al [27] , who showed longer operative times and more medical and surgical complications in obese patients (BMI >25). However, their multivariate analysis on 161 patients undergoing total gastrectomy for cancer could not identify obesity as an independent risk factor for postoperative complications.…”

Section: Discussionsupporting

confidence: 75%

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

et al. 2016

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Background: Obesity is generally considered to be associated with increased postoperative morbidity and mortality following intraabdominal cancer surgery. However, recent reports showed that overweight patients may have a lower risk for adverse postoperative outcomes and this observation has been described as the ‘obesity paradox'. Therefore, we aimed to analyze the impact of obesity on outcomes after resection for gastric cancer. Methods: Data of patients who underwent resection for gastric cancer between 2005 and 2012 were assessed. Patient characteristics, postoperative outcomes and long-term survivals were compared between patients with body mass index (BMI) ≥30 and <30. Results: Resection for gastric cancer was performed in 249 patients. BMI ≥30 was identified in 49 patients. Obese patients with BMI ≥30 were more frequently diagnosed with diabetes (31 vs. 16%, p = 0.015). Resection for gastric cancer in obese patients was significantly associated with longer duration of surgery (278 vs. 243 min, p < 0.001), longer duration of hospital stay (18 vs. 16 days, p = 0.028), increased postoperative morbidity (49 vs. 33%, p = 0.037), and increased postoperative mortality (10 vs. 3%, p = 0.028). There was no significant difference in overall survival (OS) between patients with BMI ≥30 and patients with BMI <30 (5-year OS rate: 59 vs. 62%, p = 0.587). Conclusion: Obesity may complicate resection for gastric cancer increasing the duration of surgical procedure, hospital stay and postoperative morbidity and mortality. However, BMI did not predict OS in our patients. Consequently, BMI may be too simple as a parameter to evaluate sophisticated interactions between different body fat compartments and inflammatory and immune responses and thus to predict long-term oncologic outcomes.

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Section: Discussionsupporting

confidence: 75%

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

et al. 2016

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“…18 In contrast, studies in patients after TG showed that an increased BMI was associated with greater blood loss, longer operation times, and increased rate of postoperative morbidity. 19,20 Although all of these studies used BMI alone without measurement of VFA as a parameter for obesity, results in these studies support our findings above. We consider that visceral fat is likely to have crucial influence on operative procedures during TG rather than DG.…”

Section: Discussionsupporting

confidence: 84%

Influence of Visceral Fat on Early Postoperative Outcomes After Distal and Total Gastrectomy for Gastric Cancer

Shibata

Ogawa

Koyama

et al. 2017

International Surgery

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We studied the influence of visceral fat area (VFA) on early postoperative outcomes separately after distal and total gastrectomy. The influence of obesity on outcomes might differ between distal and total gastrectomy, but few studies have directly compared the effects of VFA on early postoperative results between these 2 procedures. We reviewed clinical records of 124 patients with gastric cancer undergoing curative distal or total gastrectomy. Patients were classified into 2 groups: low (,100 cm 2 ) or high (100 cm 2 )VFA. Patient characteristics and early postoperative outcomes were compared between 2 groups separately in distal or total gastrectomy. There were 77 and 47 patients who underwent distal and total gastrectomy, respectively. After distal gastrectomy, operation time (268 6 44 versus 239 6 39 minutes, P , 0.05) as well as blood loss (351 6 231 versus 239 6 147 mL, P , 0.05) was increased in the high VFA group (N ¼ 32) compared to the low VFA group (N ¼ 45), but morbidity rates did not differ between the 2 groups (50% versus 36%). After total gastrectomy; operation time (285 6 42 versus 260 6 53 minutes, P , 0.05); blood loss (427 6 326 versus 280 6 179 mL, P , 0.05); rate of morbidity (56% versus 24%, P , 0.05); and intra-abdominal infection (17% versus 0%, P , 0.05) were increased in the high VFA group (N ¼ 18) compared to the low VFA group (N ¼ 29). These results suggest that postoperative morbidity increases after total gastrectomy but not after distal gastrectomy in patients with excessive visceral fat.Key words: Gastric cancer -Obesity -Visceral fat BMI is the best overall representative parameter for obesity, 6,7 and a BMI .25 is defined as obese in Japan. VFA is being recognized more recently as being even more important because of its metabolic implications.8 VFA is measurable in the computed tomography (CT) performed preoperatively as a routine examination to evaluate distant and LN metastases in patients with gastric cancer. Because visceral fat directly affects operative handling, VFA is likely to be more useful than BMI as a predictive factor for early postoperative outcomes. Several reports compared the effects of BMI and VFA on postoperative outcomes in patients after open gastrectomy 9-12 ; although results are somewhat different in each report, none has regarded BMI better than VFA as a predictive factor. The same is true for laparoscopic gastrectomy.13,14 Thus it is considered generally accepted that VFA is more useful than BMI as a predictive factor for postoperative outcomes.Regarding resection procedures for gastric cancer, the influence of obesity on perioperative outcomes might differ between DG and TG, but few studies have directly compared the effects of BMI or VFA on early postoperative results between DG and TG.The aim of the present study was to investigate whether the effects of visceral fat on early postoperative outcomes differ between DG and TG in patients with gastric cancer who underwent open gastrectomy. Materials and Methods PatientsIn total, 124 patients underwent...

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“…This effect could improve glucose control postoperatively, which has been demonstrated to reduce the risk of infectious complications. The higher rate of complications associated with obesity in surgery for gastric cancer is mainly attributed to an increase in the rate of surgical‐site infections . The significantly reduced HbA1c concentration in our study supports the concept that preoperative weight loss programs may reduce postoperative infectious complications.…”

Section: Discussionsupporting

confidence: 81%

Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

Inoue

Yoshiuchi

Yoshida

et al. 2018

Asian J Endoscop Surgery

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Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over‐D1” Lymphadenectomy for Gastric Cancer

Abstract: Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.

Cited by 27 publications

References 59 publications

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

Influence of Visceral Fat on Early Postoperative Outcomes After Distal and Total Gastrectomy for Gastric Cancer

Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

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