Impact of visceral fat on laparoscopy-assisted distal gastrectomy

Miyaki, Akira; Imamura, Kazuhiro; Kobayashi, Rie; Takami, Makoto; Matsumoto, Jun

doi:10.1016/j.surge.2012.07.001

Cited by 36 publications

(32 citation statements)

References 19 publications

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“…In the past, the impact of visceral fat area on surgical outcome were well elucidated [24, 25], and some studies indicated that the larger visceral or peri-organ fat areas prolonged the operative time of laparoscopic radical nephrectomy [26], laparoscopic adrenalectomy [27], and laparoscopic radical prostatectomy [28]. In the present study, we measured the retroperitoneal fat tissue thickness using preoperative standard 2-dimensional transverse CT scan images.…”

Section: Discussionmentioning

confidence: 99%

The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time

et al. 2016

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BackgroundTo investigate the impact of biological gender on operative parameters, especially operative time, in laparoscopic partial nephrectomy (LPN) for T1 renal tumor.MethodsOne hundred and eleven (28 female and 83 male) patients and 64 (20 female and 44 male) patients with renal tumors suspected to be RCC cT1aN0M0 who underwent retroperitoneal and transperitoneal LPN, respectively, were analyzed. The influence of sex on operative factors including retroperitoneal fat tissue thickness, determined on CT, was analyzed. The correlation between operative time and gender was evaluated by unpaired t-test and linear logistic regression model.ResultsIn both retroperitoneal and transperitoneal LPN, the retroperitoneal fat tissue thickness was greater in men than in women. In retroperitoneal LPN, the operative time was significantly longer in men than in women. In contrast, in transperitoneal LPN, no gender difference was observed in regard to the operative time. In retroperitoneal LPN, linear logistic regression assessment showed that gender, retroperitoneal fat tissue thickness, and tumor size were significantly associated with operative time. Coefficient of determination of the prediction model was 0.317.ConclusionsThe operative time of retroperitoneal LPN is significantly correlated with gender, maximum tumor diameter, and retroperitoneal fat tissue thickness. We have developed a prediction model for the operative time of retroperitoneal LPN based on preoperative parameters. Interestingly, in transperitoneal LPN, a gender difference in operative time was not apparent, and also predicting operative time might be difficult.

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Section: Discussionmentioning

confidence: 99%

The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time

et al. 2016

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“…However, the application of laparoscopic techniques among obese gastric cancer patients still faces the following bottlenecks. (1) It is difficult to expose the operative field, the control of bleeding is challenging, and operation times are lengthy 8 . (2) Laparoscopic surgeries are extremely difficult and risky, with a tortuous learning curve 9 , 10 ; these issues severely affect the enthusiasm of surgeons for performing these operations.…”

Section: Introductionmentioning

confidence: 99%

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Gong¹,

Cao²,

Wang³

et al. 2015

J. Cancer

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Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P <0.05). The pain score at day 2 after surgery, intestinal function recovery time, and duration of postoperative hospital stay were not significantly different for the HALG and LAG groups ( P >0.05) but were significantly better for the HALG group than for the OG group (P <0.05). There were significantly fewer postoperative complications for the HALG group than for the LAG and OG groups (P =0.049). According to the results, the “three-step HALG method” incorporates both the thoroughness of the radical OG approach and the minimal invasiveness of the LAG approach for obese patients. Thus, the HALG approach is a relatively safe and extremely feasible surgical procedure for the treatment of these patients.

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“…13,14,21 We also showed that VFA appears to be a risk factor for postoperative morbidities, intraoperative blood loss, and operation time. However, the measurement of VFA on CT requires unique software, and a more simple predictive factor is awaited that is much easier to measure and as useful as VFA.…”

Section: Discussionmentioning

confidence: 61%

“…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.…”

mentioning

confidence: 99%

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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Impact of visceral fat on laparoscopy-assisted distal gastrectomy

Cited by 36 publications

References 19 publications

The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time

The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

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

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