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

Abstract

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...