Influence of excess body weight on the surgical outcomes of total gastrectomy
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
We conducted this retrospective study to identify the influence of excess body weight on the surgical outcome of total gastrectomy (TG) and to evaluate recent advances in this operation.
The subjects were 644 consecutive gastric cancer patients who underwent TG between 1992 and 2008. Patients with a body mass index (BMI) of 25.0 kg/m2 or greater were defined as overweight (overweight group) and those with a BMI less than 25.0 kg/m2 as not overweight (non-overweight group).
The operating times were longer (P = 0.005) and intraoperative blood loss was greater (P < 0.001) in the overweight group. The incidence of overall postoperative complications (P = 0.012) and of pancreatic fistula (P < 0.001) were significantly higher in the overweight group. In recent years, we achieved a reduction in operating time (P < 0.001), intraoperative blood loss (P = 0.033), and incidence of pancreatic fistula (P = 0.005), while maintaining curability, in the overweight group.
Although TG for gastric cancer is technically more difficult in overweight patients, they should not be denied this operation. Conversely, we should make a greater effort to improve the surgical outcomes of overweight patients.
- Popkin BM, Doak CM. The obesity epidemic is a worldwide phenomenon. Nutr Rev 1998;56:106–114. CrossRef
- World Health Organization. Obesity: preventing and managing the global epidemic. WHO obesity technical report series 894. Geneva, Switzerland: World Health Organization; 2000.
- Noguchi Y, Yoshikawa T, Tsuburaya A, Motohashi H, Karpeh MS, Brennan MF. Is gastric carcinoma different between Japan and the United States? Cancer 2000;89:2237–2246. CrossRef
- Yoshiike N, Seino F, Tajima S, Arai Y, Kawano M, Furuhata, et al. Twenty-year changes in the prevalence of overweight in Japanese adults: The National Nutrition Survey 1976–95. Obes Rev 2002;3: 183–190. CrossRef
- Kubo M, Sano T, Fukunaga T, Katai H, Sasako M. Increasing body mass index in Japanese patients with gastric cancer. Gastric Cancer 2005;8:39–41. CrossRef
- Catalano V, Labianca R, Beretta GD, Gatta G, de Braud F, Van Cutsem E. Gastric cancer. Crit Rev Oncol Hematol 2005;54:209–241. CrossRef
- Siewert JR, Bottcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–461. CrossRef
- Roukos DH, Lorenz M, Encke A. Evidence of survival benefit of extended (D2) lymphadenectomy in western patients with gastric cancer based on a new concept: a prospective long-term follow-up study. Surgery 1998;123:573–578. CrossRef
- Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006;7:309–315. CrossRef
- Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer 2002;9:278–286.
- Ohdaira H, Nimura H, Takahashi N, Mitsumori N, Kashiwagi H, Narimiya N, et al. The possibility of performing a limited resection and a lymphadenectomy for proximal gastric carcinoma based on sentinel node navigation. Surg Today 2009;39:1026–1031. CrossRef
- Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, et al. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 2000;59:18–23. CrossRef
- Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995–999. CrossRef
- Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22: 2069–2077. CrossRef
- Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748. CrossRef
- Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer 2000;3: 141–144. CrossRef
- Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol 2007;14:355–361. CrossRef
- Nobuoka D, Gotohda N, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg 2008;32:2261–2266. CrossRef
- Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532–536. CrossRef
- Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma (2nd English ed.). Gastric Cancer 1998;1: 10–24. CrossRef
- Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810–1820. CrossRef
- Lindblad M, Rodríguez LA, Lagergren J. Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric noncardia adenocarcinoma among men and women in a nested casecontrol study. Cancer Causes Control 2005;16:285–294. CrossRef
- Lagergren J, Bergström R, Nyrén O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 1999;130:883–890.
- Orengo MA, Casella C, Fontana V, Filiberti R, Conio M, Rosso S, et al. Trends in incidence rates of oesophagus and gastric cancer in Italy by subsite and histology, 1986–1997. Eur J Gastroenterol Hepatol 2006;18:739–746. CrossRef
- Japanese Gastric Cancer Association Registration Committee. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric cancer 2006;9:51–66. CrossRef
- Adachi W, Kobayashi M, Koike S, Rafique M, Nimura Y, Kuroda T, et al. The influence of excess body weight on the surgical treatment of patients with gastric cancer. Surg Today 1995;25:939–945. CrossRef
- Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamaguchi T, Nakajima T. Better 5-year survival rate following curative gastrectomy in overweight patients. Ann Surg Oncol 2009;16:3245–3251. CrossRef
- Prentice AM, Jebb SA. Beyond body mass index. Obes Rev 2001;2:141–147. CrossRef
- Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T. Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg 2009;96:496–500. CrossRef
- Pi-Sunyer FX. Obesity: criteria and classification. Proc Nutr Soc 2000;59:505–509.
- Srikanthan P, Seeman TE, Karlamangla AS. Waist-hip-ratio as a predictor of all-cause mortality in high-functioning older adults. Ann Epidemiol 2009;19:724–731. CrossRef
- Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg 1997;185:593–603. CrossRef
- Bray GA, Bellanger T. Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 2006;29:109–117. CrossRef
- Influence of excess body weight on the surgical outcomes of total gastrectomy
Volume 41, Issue 7 , pp 928-934
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Gastric cancer
- Total gastrectomy
- Surgical outcome
- Body mass index
- Industry Sectors