Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients

Yasuda, Kazuhiro; Ito, Masafumi; Shiraishi, Norio; Izumi, Koichi; Ishikawa, Koichi; Kitano, Seigo

doi:10.1007/s00464-003-9310-7

Cited by 63 publications

(56 citation statements)

References 18 publications

(19 reference statements)

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“…Noshiro et al [24] have shown that LADG for heavier patients was associated with more technical difficulties and the disadvantages of a longer operation time and delayed recovery of bowel activity, compared with findings in normal-weight patients. In the report of Yasuda et al [25], the operation time was longer in the obese group, but no differences were found in the other operative parameters. Our study showed that there were no statistically significant differences between our two BMI groups in age, sex, depth of tumor invasion, lymph node metastasis, operation time, postoperative leukocyte count, number of patients requiring transfusion, the time interval to first flatus, the postoperative hospital stay, and the postoperative complications.…”

Section: Discussionmentioning

confidence: 76%

The impact of obesity on LADG for early gastric cancer

Kim

Jung

et al. 2006

Gastric Cancer

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Section: Discussionmentioning

confidence: 76%

The impact of obesity on LADG for early gastric cancer

Kim

Jung

et al. 2006

Gastric Cancer

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“…Longer operation times for obese patients are predictable and have been reported repeatedly [8][9][10]. However, fewer numbers of retrieved LNs in obese patients is an unexpected finding that has rarely been reported.…”

Section: Discussionmentioning

confidence: 92%

“…Many largescale studies have repeatedly demonstrated that obesity influences surgical outcomes after gastric cancer surgery [7,[19][20][21]. Conversely, studies focusing on LAG have shown that obesity does not increase surgical morbidity [8][9][10]. However, the limited numbers of patients in these studies (usually fewer than 100) make these results very inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Lee

Kim

et al. 2009

Surg Endosc

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Background Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. Methods The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI C 25 kg/m 2 ; n = 432) and low BMI (BMI \25 kg/ m 2 ; n = 1,053) groups, and their clinical outcomes were compared. Results The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p \ 0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. Conclusions High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

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“…Some studies have suggested that obesity does not affect postoperative morbidity or mortality. 13,14 However, a longer operation time has been noted in obese patients. 7 This study evaluated the postoperative complication rate after laparoscopic distal gastrectomy and the safety of laparoscopic distal gastrectomy in patients with a high BMI.…”

Section: Discussionmentioning

confidence: 99%

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

Choi

Kim

Yoo

et al. 2017

J Minim Invasive Surg

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Purpose:In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes. Methods:A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m 2 versus ≥30 kg/m 2 . Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results.Results: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients. Conclusion:LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.

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Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients

Abstract: The only difference between our two study groups was that LDG required a longer operating time in obese patients; morbidity and length of hospital stay were not increased. Thus, we believe that LDG is likely to become the treatment of choice for obese patients with early gastric cancer.

Cited by 63 publications

References 18 publications

The impact of obesity on LADG for early gastric cancer

The impact of obesity on LADG for early gastric cancer

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Comparison Surgical Outcomes between Laparoscopic and Conventional Distal Gastrectomy for Early Gastric Cancer in Obese Patients

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