The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

Abstract

Background: Obesity is generally considered to be associated with increased postoperative morbidity and mortality following intraabdominal cancer surgery. However, recent reports showed that overweight patients may have a lower risk for adverse postoperative outcomes and this observation has been described as the ‘obesity paradox'. Therefore, we aimed to analyze the impact of obesity on outcomes after resection for gastric cancer. Methods: Data of patients who underwent resection for gastric cancer between 2005 and 2012 were assessed. Patient characteristics, postoperative outcomes and long-term survivals were compared between patients with body mass index (BMI) ≥30 and <30. Results: Resection for gastric cancer was performed in 249 patients. BMI ≥30 was identified in 49 patients. Obese patients with BMI ≥30 were more frequently diagnosed with diabetes (31 vs. 16%, p = 0.015). Resection for gastric cancer in obese patients was significantly associated with longer duration of surgery (278 vs. 243 min, p < 0.001), longer duration of hospital stay (18 vs. 16 days, p = 0.028), increased postoperative morbidity (49 vs. 33%, p = 0.037), and increased postoperative mortality (10 vs. 3%, p = 0.028). There was no significant difference in overall survival (OS) between patients with BMI ≥30 and patients with BMI <30 (5-year OS rate: 59 vs. 62%, p = 0.587). Conclusion: Obesity may complicate resection for gastric cancer increasing the duration of surgical procedure, hospital stay and postoperative morbidity and mortality. However, BMI did not predict OS in our patients. Consequently, BMI may be too simple as a parameter to evaluate sophisticated interactions between different body fat compartments and inflammatory and immune responses and thus to predict long-term oncologic outcomes.

A prospective appraisal of preoperative body mass index in D2-resected patients with non-metastatic gastric carcinoma and Siewert type II/III adenocarcinoma of esophagogastric junction: results from a large-scale cohort

“…Previous retrospective evidence concerning the prognostic role of BMI in GC remains controvertial. Some supported that higher pretreatment BMI did not meaningfully predict postoperative survival [ 30 , 32 , 44 , 56 , 64 – 66 ], some indicated a positive association between BMI and postoperative survival [ 33 , 34 , 67 ], while others suggested a negative correlation [ 68 ]. The different findings could partly due to the fact that some other researches did not adjust confounding factors as thoroughly as we did, which could then hopefully reveal the true associations.…”

“…Due to potentially different inclusion criteria and regions, researches revealed controversial association of overweight/obesity and surgical parameters including operation duration and lymph node ratio [ 28 – 30 , 65 , 73 ]. Overweight and obesity might be associated with more comorbidities [ 74 ], and potentially increase the complexity and difficulty of gastric surgery [ 32 , 64 , 68 ]. Both underweight and overweight increased postoperative complications [ 68 , 75 ].…”

Obesity as a surgical risk factor

“…Chen et al reported an obesity paradox wherein overall survival was significantly better in patients with BMI > 25 than in those with normal BMI. Nonetheless, other than the aforementioned report, many studies failed to demonstrate any influence of obesity on long‐term survival . By contrast, Struecker et al described short‐term survival (postoperative death) as being significantly poorer in patients with BMI > 30, whereas Kurita et al described survival as tending to be less favorable in those with BMI > 25.…”

“…Nonetheless, other than the aforementioned report, many studies failed to demonstrate any influence of obesity on long‐term survival . By contrast, Struecker et al described short‐term survival (postoperative death) as being significantly poorer in patients with BMI > 30, whereas Kurita et al described survival as tending to be less favorable in those with BMI > 25. Obesity may have a negative influence on the short‐term survival of patients who have undergone gastrectomy.…”

The Shortest Distance from the Skin to Pancreas and the Lower Sternum Angle can Influence Short-Term Surgical Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

“…Obesity has always been considered as a factor that can not be ignored. Obesity may lead to a decrease in the number of retrieved lymph node, prolong hospital stay, and poor prognosis [6][7][8].…”