The impact of obesity on esophagectomy: a meta-analysis

Mengardo, Valentina; Pucetti, F; Cormack, Orla Mc; Chaudry, Asif; Allum, William

doi:10.1093/dote/dox149

Cited by 43 publications

(40 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The association between a BMI of ≥26 kg/m 2 and higher incidence of anastomotic leakage was also found in other studies and could be explained by a higher rate of intra‐operative complications such as accidental injury and ischaemia …”

Section: Discussionsupporting

confidence: 76%

See 1 more Smart Citation

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Hagens

Feenstra

Egmond

et al. 2020

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Background Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post‐operative morbidity and long‐term survival. Methods This retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross‐sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx. Results A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post‐operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87–0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30–2.53, P = 0.001) were associated with worse overall survival. Conclusions Sarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.

show abstract

Section: Discussionsupporting

confidence: 76%

“…Furthermore, two reviews showed that patients with a high BMI have a better overall 5 years of survival, which was not encountered in the present study . This phenomenon is also seen in other types of cancer and is called the BMI paradox.…”

Section: Discussionsupporting

confidence: 41%

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Hagens

Feenstra

Egmond

et al. 2020

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

show abstract

“…While overall postoperative morbidity rates appear to be similar among patients with obesity compared with normal weight and underweight individuals, specific complications may be increased among patients with obesity. A recent meta-analysis reported a markedly increased risk of anastomotic leak, up to 35%, among patients with BMI-defined obesity, but otherwise similar postoperative outcomes (26). A clear technical difficulty may be the preparation of an optimal gastric conduit, without tension.…”

Section: Surgerymentioning

confidence: 99%

“…Notwithstanding a clear epidemiologic association, the impact of VO and MetS on oncologic outcomes of EAC remains uncertain, with various data suggesting improved, worsened or an unchanged survival and treatment outcomes (24)(25)(26)(27). With respect to esophageal cancer surgery, although VO may impact operative outcomes through increased technical difficulty, and associated comorbidities may increase perioperative risk, the current literature are highly inconsistent in this regard (26), possibly due to the differential impact of various stages of obesity and comorbidity on perioperative risk, and the confounding effect of malnutrition and loss of lean body mass, known as sarcopenia, which is present in many patients with esophageal cancer (28,29). Across oncology a greater understanding of obesity and tumor biology is sought, and a 2014 statement from the American Society of Clinical Oncology (ASCO) commits to addressing this issue through increased education, and the delivery resources for healthcare professionals to tackle obesity in partnership with patients, in addition to increasing provisions for public health policy supporting the prevention and treatment of obesity (30).…”

Section: Introductionmentioning

confidence: 99%

Visceral Obesity, Metabolic Syndrome, and Esophageal Adenocarcinoma

Elliott

Reynolds

2021

Front. Oncol.

View full text Add to dashboard Cite

Esophageal adenocarcinoma (EAC) represents an exemplar of obesity-associated carcinogenesis, with a progressive increase in EAC risk with increased body mass index. In this context, there is increased focus on visceral adipose tissue and associated metabolic dysfunction, including hypertension, diabetes mellitus and hyperlipidemia, or combinations of these in the metabolic syndrome. Visceral obesity (VO) may promote EAC via both directly impacting on gastro-esophageal reflux disease and Barrett's esophagus, as well as via reflux-independent effects, involving adipokines, growth factors, insulin resistance, and the microbiome. In this review these pathways are explored, including the impact of VO on the tumor microenvironment, and on cancer outcomes. The current evidence-based literature regarding the role of dietary, lifestyle, pharmacologic and surgical interventions to modulate the risk of EAC is explored.

show abstract

“…This study was followed by several reports from Asian countries confirming these results for oesophageal and gastric adenocarcinoma, and GC, but reporting discordant results for oesophageal SCC …”

Section: Discussionmentioning

confidence: 53%

Short‐term and long‐term outcomes of oesophagogastric surgery for cancer in obese and normal weight patients

Glatz

Kulemann

Kuvendjiska

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background Obesity is generally considered to be associated with worse surgical outcome and impaired oncological prognosis. The impact of pre‐therapeutic body mass index (BMI) in patients with oesophagogastric cancer on the surgical outcome is controversially discussed. Methods We retrospectively examined 730 patients who had undergone curative treatment for oesophagogastric cancer at the Medical Center of the University of Freiburg (1996–2015). Patients were divided in groups according to pre‐therapeutic BMI (underweight (UW): <18.5 kg/m2; normal weight (NW): 18.5–25 kg/m2; overweight (OW): 25–30 kg/m2; and obese (OB): >30 kg/m2). Results Median BMI was 24.7 kg/m2. Forty‐two patients were UW, 337 NW, 263 OW and 84 OB. No significant differences between the groups (UW/NW/OW/OB) in operating time, hospital stay, perioperative complication rate and in‐hospital mortality were found. Pre‐therapeutic BMI was significantly associated with 5‐year survival (UW: 22%, NW: 37%, OW: 51%, OB: 50%, P < 0.001). Multivariate analysis identified UW/NW (BMI <25 kg/m2) as an independent risk factor for poor survival (relative risk 1.38, P = 0.001) among high American Society of Anesthesiologists score, old age, positive resection margin and high cancer stage according to the Union Internationale Contre le Cancer (UICC). Conclusion In oesophagogastric cancer, OW and OB patients can be treated surgically without impaired perioperative outcome and expect improved long‐term survival compared to patients with a BMI <25 kg/m2.

show abstract

The impact of obesity on esophagectomy: a meta-analysis

Cited by 43 publications

References 32 publications

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Visceral Obesity, Metabolic Syndrome, and Esophageal Adenocarcinoma

Short‐term and long‐term outcomes of oesophagogastric surgery for cancer in obese and normal weight patients

Contact Info

Product

Resources

About