Prognostic significance of body mass indices for patients undergoing esophagectomy for cancer

Abstract

The aim of this study was to determine the role of body mass index (BMI) in a Western population on outcomes after esophagectomy for cancer. Two hundred and fifteen consecutive patients undergoing esophagectomy for esophageal cancer of any cell type were studied prospectively. Patients with BMIs > 25 kg/m were classified as overweight and compared with control patients with BMIs below these reference values. Ninety-seven patients (45%) had low or normal BMIs, 86 patients (40%) were overweight, and a further 32 (15%) were obese. High BMIs were associated with a higher incidence of adenocarcinoma versus squamous cell carcinoma (83%vs. 14%, P = 0.041). Operative morbidity and mortality were 53% and 3% in overweight patients compared with 49% (P = 0.489) and 8% (P = 0.123) in control patients. Cumulative survival at 5 years was 27% for overweight patients compared with 38% for control patients (P = 0.6896). In a multivariate analysis, age (hazard ratio [HR] 1.492, 95% CI 1.143-1.948, P = 0.003), T-stage (HR 1.459, 95% CI 1.028-2.071, P = 0.034), N-stage (HR 1.815, 95% CI 1.039-3.172, P = 0.036) and the number of lymph node metastases (HR 1.008, 95% CI 1.023-1.158, P = 0.008), were significantly and independently associated with durations of survival. High BMIs were not associated with increased operative risk, and long-term outcomes were similar after R0 esophagectomy.

The obesity paradox in the surgical population

“…33,46,48 Overweight and obese patients showed conflicting results regarding long-term survival. Studies in vascular surgery, 45 oncology surgery 29,30 and cardiac surgery 37 reported survival benefit for overweight and obese patients, whereas other studies in oncology surgery 25 and cardiac surgery 47 did not demonstrate any association with long-term survival. Table 2 gives an overview of different patient populations in which an inverse relationship between BMI and mortality was demonstrated.…”

Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review

“…17 A more recent study from Europe found that BMI >25 kg/m 2 was not associated with worse outcomes in 215 patients undergoing oesophagectomy for cancer; specifically, there were no differences in operative times (median 280 min in both normal or high BMI), morbidity (49% vs 53%, p=0.4), mortality (8.3% vs 3.4%, p=0.1) and median number of harvested lymph node (14 vs 11, p=0.054). 18 Two recent studies by Blom et al 19 and Grotenhius et al 20 have both demonstrated that patients with elevated BMI do not experience an increase in operative outcomes or oncological outcomes. However, Blom and colleagues did demonstrate an increase in anastomotic leaks in the obese population, a finding which we did not corroborate.…”

The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy

“…A few reports that specifically focused on BMI suggested that pretreatment BMI was not associated with differential outcome with regard to OS or DFS. [12][13][14] However, the largest study to date is by Trivers et al 17 18 demonstrated that a BMI of >18 kg/m 2 was one of the independent prognostic factors in 105 patients treated with definitive chemoradiotherapy (P ¼ .003). However, in this study, the cutpoint for BMI was nontraditional and the sample size was small.…”

“…8 High BMI is a risk factor for gastroesophageal reflux disease (GERD) and, consequently, for EAC. [9][10][11] Several studies have reported that high BMI was not associated with improved or reduced overall survival (OS) after esophagectomy, [12][13][14] although increased postoperative morbidity, such as respiratory complications, anastomotic leaks, and length of hospital stay, have been associated with high BMI in patients with gastroesophageal cancer who are undergoing surgery. 14,15 Many of these studies included small number of patients, in whom adjunctive therapy (preoperative chemotherapy and/or radiotherapy) was used.…”