Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

Abstract

BackgroundObesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.MethodsWe reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients.ResultsA total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.ConclusionsObesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.

Effect of High Body Mass Index on Short- and Long-term Outcomes of Patients who Underwent Laparoscopic Gastrectomy for Advanced Gastric Cancer: A Case Control Study

“…Similarly, extra time will be consumed in dissecting the intra-abdominal adipose tissue, which leads to a longer duration of surgery. In accordance with previous studies [1,21,23], our study found that patients with high BMI had longer operation time and more intraoperative bleeding as compared to patients with normal BMI during the laparoscopic procedures. Moreover, our findings showed that high BMI was associated with shorter time to flatus, start of soft diet, drain tube removal and hospitalization (all P < 0.05), which was rarely reported before.…”

“…While Shimada et al reported that patients with high BMI were at a higher risk for insufficient regional lymph nodes removal, leading to an increased risk of local recurrence and worse survival [16,21], several studies have reported that excessive fat had little effect on the number of retrieved lymph nodes during LG [1,11,17,18,23,26,28]. Our study indicated that no significant difference was observed in terms of the number of retrieved lymph nodes between the two BMI groups.…”

Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis

“…Obesity is one of the most significant health problems today and rates are still increasing around the world. Some studies claim obesity causes increased blood loss, operation time, and wound infection rate et al [ 50 , 51 ], whereas others did not observe any negative effect on surgical outcomes [ 52 ]. Recently, Harr et al [ 10 ] showed that the benefits of robotic methods were more evident in high versus normal BMI patients when performing a colostomy.…”

Surgical Outcomes and Follow-Up Results of 100 Cases of Laparoscopic Total Gastrectomy Using the Overlap Method with Stapled Closure

“…Regarding extent of lymphadenectomy, surgical treatment for advanced tumors required additional removal of lymph nodes around proper hepatic artery, distal half of splenic artery, and/ or splenic hilum. Moreover, some previous studies reported that operation time was longer in obese patients of BMI over 25 during laparoscopic distal gastrectomy 19,20 The surgeon Fig. 2.…”