Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

Inoue, Kentaro; Yoshiuchi, Sawako; Yoshida, Mika; Nakamura, Natsuko; Nakajima, Sachiko; Kitamura, Akiko; Mouri, Keiko; Michiura, Taku; Matsubara, Hiromi; Ozaki, Takashi; Miki, Hirokazu; Yanagimoto, Hiroaki; Satoi, Sohei; Kaibori, Masaki; Hamada, Masanori; Kimura, Yutaka; Kon, Masanori

doi:10.1111/ases.12479

Cited by 18 publications

(31 citation statements)

References 33 publications

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“…[ 9 ] In a similar program for obese patients with gastric cancer, a mean weight loss of 4.5%, corresponding to 3.2 kg, was reported, indicating the relative superiority of our approach. [ 10 ] In the gynecologic field, there have been no reports on weight reduction programs before surgery. Thus, to our knowledge, this is the first such study that was performed as we often treat obese women with endometrial cancer at our center.…”

Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

Imai

Chikazawa

Ito

et al. 2021

Gynecol Minim Invasive Ther

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Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

Imai

Chikazawa

Ito

et al. 2021

Gynecol Minim Invasive Ther

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“…All surgeons agreed that they would recommend implementation of this model in other facilities and that VLCD‐based treatment had positively affected surgical procedures, although this was subjective data. Three studies have previously measured surgical outcomes for patients prescribed VLCDs before non‐bariatric surgery, which showed reduced blood loss for gastrectomy ( P < 0.05) ( 38 ) , 20% shorter operating time for laparoscopic cholecystectomy ( P < 0.05) ( 23 ) and nil differences in surgical outcomes for liver resection ( 39 ) . Only one of these involved scheduled dietitian appointments (gastrectomy) and one utilised ‘explicit written dietary instructions’ provided by their surgeon (liver resection).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a dietitian‐led very low calorie diet (VLCD) based model of care to facilitate weight loss for obese patients prior to elective, non‐bariatric surgery

Griffin

Ross

Burstow

et al. 2020

J Human Nutrition Diet

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Background Elective surgery in obese adults carries a higher risk of post‐operative infection and prolonged hospital stays, and surgeons may postpone surgery for patients with obesity until they lose weight. The present study aimed to determine the efficacy of a dietitian‐led very low calorie diet (VLCD)‐based model of care with respect to achieving weight loss for obese patients prior to surgery. Methods This mixed‐methods study included a medical chart audit of patients referred to a VLCD‐based model over 23 months, as well as a survey of recently treated patients and surgeons who utilised the model. Preoperative weight loss targets were set by surgeons, and the dietitian prescribed individualised VLCD‐based treatment. Efficacy was determined as weight loss considered sufficient for surgery, clinical safety of VLCD‐based treatment, feasibility, and stakeholder value. Pre/post‐intervention differences in clinical measures were explored by paired t‐test or Wilcoxon tests as appropriate. Results Data on seventy‐eight eligible patients [mean (SD) 45 (13) years, 90% female, body mass index 44.3 (6.2) kg m–2] demonstrated significant mean (SD) weight loss of 7.4% (5.3%) body weight (P < 0.05). Most patients (70%, n = 50/71) achieved sufficient weight loss to proceed to surgery. Fifty‐six per cent of patients reported mild side effects (n = 43/77) and none led to treatment cessation. Surgeons reported VLCD‐based treatment made operations easier (83%, n = 10/12) and shorter (75%, n = 9/12) and all recommended the model of care. All surveyed patients (n = 24) reported satisfaction with their VLCD‐based model experience. Conclusions A dietitian‐led VLCD‐based model achieved sufficient weight loss to facilitate elective surgery for most patients. The approach was feasible, highly valued by patients and surgeons, and resulted in perceived surgical benefits.

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“…Inoue et al found that a very low-calorie diet preoperatively without exercise therapy reduced the body fat mass in patients with early gastric cancer. In this study, one of the daily meals (breakfast, lunch, or dinner) was changed to very low-calorie diet during preoperative 20 days [9]. However, careful consideration of this type of intervention is needed because malnutrition and sarcopenia are significant unfavorable prognostic predictors for survival in gastric cancer [31,32].…”

Section: Discussionmentioning

confidence: 99%

“…In these reports, visceral obesity is usually defined as a visceral fat area (VFA) ≥100 cm 2 measured using computed tomography (CT) [2][3][4][5][6][7]. e VFA can be reduced over a short preoperative period, unlike risk factors, such as age, sex, comorbidity, and cancer stage [8,9]. erefore, preoperative intervention for patients with high VFA may be effective for decreasing the incidence of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat

Okada

Nishigori

Obama

et al. 2019

Journal of Oncology

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Background. Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods. Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results. total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P<0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P<0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion. The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.

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Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

Abstract: The preoperative 20-day very low-calorie diet weight loss program is promising for the treatment of obesity before laparoscopic gastrectomy for gastric cancer.

Cited by 18 publications

References 33 publications

Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

Efficacy of a dietitian‐led very low calorie diet (VLCD) based model of care to facilitate weight loss for obese patients prior to elective, non‐bariatric surgery

The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat

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