Prognostic Value of Body Mass Index on Short‐Term and Long‐Term Outcome after Resection of Esophageal Cancer

Abstract

IntroductionCachexia and obesity have been suggested to be risk factors for postoperative complications. However, high body mass index (BMI) might result in a higher R0-resection rate because of the presence of more fatty tissue surrounding the tumor. The purpose of this study was to investigate whether BMI is of prognostic value with regard to short-term and long-term outcome in patients who undergo esophagectomy for cancer.MethodsIn 556 patients who underwent esophagectomy (1991–2007), clinical and pathological outcome were compared between different BMI classes (underweight, normal weight, overweight, obesity).ResultsOverall morbidity, mortality, and reoperation rate did not differ in underweight and obese patients. However, severe complications seemed to occur more often in obese patients (p = 0.06), and the risk for anastomotic leakage increased with higher BMI (12.5% in underweight patients compared with 27.6% in obese patients, p = 0.04). Histopathological assessment showed comparable pTNM stages, although an advanced pT stage was seen more often in patients with low/normal BMI (p = 0.02). A linear association between BMI and R0-resection rate was detected (p = 0.02): 60% in underweight patients compared with 81% in obese patients. However, unlike pT-stage (p < 0.001), BMI was not an independent predictor for R0 resection (p = 0.12). There was no significant difference in overall or disease-free 5-year survival between the BMI classes (p = 0.25 and p = 0.6, respectively).ConclusionsBMI is not of prognostic value with regard to short-term and long-term outcome in patients who undergo esophagectomy for cancer and is not an independent predictor for radical R0 resection. Patients oncologically eligible for esophagectomy should not be denied surgery on the basis of their BMI class.

A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

“…Operative approach (transhiatal vs. transthoracic) is also reported to be highly correlated to the development of pulmonary complications [2,20]. In accordance with other reports, the American Society of Anesthesiologists (ASA) score and BMI were not associated with treatment of pneumonia in our series [20,27]. …”

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

“…Grotenhuis et al 61. reported that BMI was not of prognostic value for short‐ and long‐term outcomes in patients who underwent esophagectomy for cancer and it is not an independent predictor for radical (R0) resection.…”

Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy

“…Our results may suggest that chest physical therapy stimulates lung expansion and improves lung ventilation, thereby preventing or eliminating the build-up of liquid in the pleural space, meeting the drainage removal criteria (less than 100 mL in 24 hours) earlier and facilitating the removal of the drain 21 . Re-intubation for respiratory failure in patients undergoing esophagectomy varies from 9% to 17% of the cases [22][23][24] . This frequency in our study has been lower (6.6%) in the control group and even lower in the PTG (2.5%), possibly due to protective effect of physical therapy intervention in this population, which had decreased significantly since the frequency of respiratory complications.…”