Influence of excess body weight on the surgical outcomes of total gastrectomy

Nobuoka, Daisuke; Gotohda, Naoto; Kato, Yukio; Takahashi, Shinichiro; Konishi, Masaru; Kinoshita, Taira

doi:10.1007/s00595-010-4397-7

Cited by 27 publications

(26 citation statements)

References 33 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

supporting

confidence: 82%

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

Shibata

Ogawa

Koyama

et al. 2017

International Surgery

View full text Add to dashboard Cite

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...

show abstract

supporting

confidence: 82%

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

Shibata

Ogawa

Koyama

et al. 2017

International Surgery

View full text Add to dashboard Cite

show abstract

“…In addition, Dhar et al [17] suggested that a higher BMI is closely related to disease recurrence after gastric cancer surgery because of difficulties in dissecting lymph nodes in obese patients. In our report, there were 41 overweight and 54 nonoverweight patients; there were many more overweight patients than in Nobuoka's study (84.6% vs. 15.46%, respectively) [30]. Thus, there may be selection bias effects of too many overweight patients in our study.…”

Section: Discussionmentioning

confidence: 60%

“…The exact cause was not disclosed in our study. However, Nobuoka et al [30] reported the operating times were longer in the overweight group. In addition, Dhar et al [17] suggested that a higher BMI is closely related to disease recurrence after gastric cancer surgery because of difficulties in dissecting lymph nodes in obese patients.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of postoperative neutrophils to lymphocytes ratio in predicting long-term recurrence after stomach cancer surgery

Kim

Choi

2012

J Korean Surg Soc

View full text Add to dashboard Cite

PurposeImmunosuppression is a characteristic of cancer recurrence after curative resection. The neutrophil-to-lymphocyte ratio (NL ratio) in peripheral blood is associated with immune function. However, it is not clear whether the postoperative NL ratio is a predictor for cancer relapse after resection. Thus, we investigated the effectiveness of the short-term postoperative NL ratio in the prediction of disease recurrence within 5 years after stomach cancer surgery by a retrospective chart review.MethodsNinety-three patients with stomach cancer were enrolled. Significant risk factors for cancer recurrence were determined by multivariate Cox regression. Independent variables to increase the NL ratio to >7.7 by postoperative day (POD) 3 were examined by multivariate logistic regression analysis.ResultsThe 5-year risk of cancer recurrence after gastrectomy was 4.2 times higher for patients with a POD3 NL ratio of >7.7 (P = 0.005), 3.4 times higher for normal-weight patients compared with overweight patients (P = 0.008), and 20 times higher for stage III compared with stage 0 according to the tumor-node-metastasis cancer staging system (P = 0.003). The surgical duration (hours) increased the chance of high NL ratio >7.7 (odds ratio, 2.5; P = 0.006).ConclusionThe postoperative NL ratio, especially the POD3 NL ratio, predicts long-term recurrence after stomach cancer surgery.

show abstract

“…Overall operative time was included in the majority of studies and was the only reported outcome that was associated with obesity in a majority of publications (Table ) . Among the 70 studies that included operative time as an outcome metric, 42 (60%) reported that obesity was associated with a longer operative time …”

Section: Resultsmentioning

confidence: 99%

“…For example, in one study the increase in operative time for each 1 unit of increase in BMI was only 2 min per case . In another study, while the operative time among obese patients was longer, the average difference was only about 20 min in obese versus non‐obese patients . While operative time may affect health care costs, the relation of modest increases in operative time with patient and hospital outcomes needs to be further defined.…”

Section: Discussionmentioning

confidence: 99%

Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

Hughes

Shah

Noria

et al. 2018

Journal of Surgical Oncology

View full text Add to dashboard Cite

We systematically reviewed 118 studies comparing peri-operative outcomes among obese and non-obese patients. Obesity was associated with longer operative time in 60% of available studies. Just 35.8% of studies that evaluated overall morbidity identified high morbidity in obese patients. Lymph node yield or surgical margin status, was only affected by obesity in 19.6% of studies. In this review obesity was frequently found to have no effect on peri-operative and oncologic outcomes.

show abstract

Influence of excess body weight on the surgical outcomes of total gastrectomy

Abstract: Although TG for gastric cancer is technically more difficult in overweight patients, they should not be denied this operation. Conversely, we should make a greater effort to improve the surgical outcomes of overweight patients.

Cited by 27 publications

References 33 publications

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

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

The effectiveness of postoperative neutrophils to lymphocytes ratio in predicting long-term recurrence after stomach cancer surgery

Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

Contact Info

Product

Resources

About