Annals of Surgical Oncology

, Volume 14, Issue 2, pp 355–361

Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501)

  • Toshimasa Tsujinaka
  • Mitsuru Sasako
  • Seiichiro Yamamoto
  • Takeshi Sano
  • Yukinori Kurokawa
  • Atsushi Nashimoto
  • Akira Kurita
  • Hitoshi Katai
  • Toshio Shimizu
  • Hiroshi Furukawa
  • Satoru Inoue
  • Masahiro Hiratsuka
  • Taira Kinoshita
  • Kuniyoshi Arai
  • Yoshitaka Yamamura
Article

DOI: 10.1245/s10434-006-9209-3

Cite this article as:
Tsujinaka, T., Sasako, M., Yamamoto, S. et al. Ann Surg Oncol (2007) 14: 355. doi:10.1245/s10434-006-9209-3

Abstract

Background

The impact of overweight on the outcome of gastrectomy with lymphadenectomy is controversial, and data from a well-controlled, randomized study are needed to identify a possible relationship.

Methods

We used data from 523 patients registered for a prospective randomized trial comparing D2 and extended para-aortic D3 lymphadenectomy to compare the effects of body mass index (BMI) and the extent of lymphadenectomy for the development of general or major surgical complications (anastomotic leakage, abdominal abscess, and pancreatic fistula).

Results

Seventy-seven patients were classified as overweight with BMI ≥ 25, and 38 and 39 of these patients underwent a D2 or D3 lymphadenectomy, respectively. Among the 446 patients classified as nonoverweight with BMI < 25, 225 received D2 and 221 received D3 lymphadenectomy. Surgical complications, operation time, and blood loss were statistically significantly associated with BMI, and logistic regression analysis revealed that overweight directly affected the occurrence of surgical complications even after considering operation time and blood loss as intermediate factors instead of outcome variables. Among patients undergoing D2 lymphadenectomy, being overweight increased the risk for surgical complications and blood loss, whereas overweight was associated with only blood loss and operation time among patients receiving D3 lymphadenectomy.

Conclusions

Overweight increased the risk of surgical complications in patients undergoing gastrectomy both directly and indirectly through operation time and blood loss. The impact of overweight on surgical complications was more evident in patients undergoing a D2 dissection.

Keywords

OverweightBMIComplicationGastric cancerRCTJCOG

Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Toshimasa Tsujinaka
    • 1
  • Mitsuru Sasako
    • 2
  • Seiichiro Yamamoto
    • 3
  • Takeshi Sano
    • 2
  • Yukinori Kurokawa
    • 3
  • Atsushi Nashimoto
    • 4
  • Akira Kurita
    • 5
  • Hitoshi Katai
    • 2
  • Toshio Shimizu
    • 6
  • Hiroshi Furukawa
    • 7
  • Satoru Inoue
    • 8
  • Masahiro Hiratsuka
    • 9
  • Taira Kinoshita
    • 10
  • Kuniyoshi Arai
    • 11
  • Yoshitaka Yamamura
    • 12
  1. 1.Department of SurgeryOsaka National HospitalChuo-kuJapan
  2. 2.Gastric Surgery DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Cancer Information and Epidemiology DivisionNational Cancer Center Research InstituteTokyoJapan
  4. 4.Department of SurgeryNiigata Cancer Center HospitalNiigataJapan
  5. 5.Department of SurgeryNational Shikoku Cancer CenterMatsuyamaJapan
  6. 6.Department of SurgeryInternational Medical Center of JapanTokyoJapan
  7. 7.Department of SurgerySakai Municipal HospitalSakaiJapan
  8. 8.Department of SurgeryTokyo Metropolitan Bokutoh HospitalTokyoJapan
  9. 9.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseaseOsakaJapan
  10. 10.Department of SurgeryNational Cancer Center EastTokyoJapan
  11. 11.Department of SurgeryTokyo Metropolitan Komagome HospitalTokyoJapan
  12. 12.Department of SurgeryAichi Cancer CenterAichiJapan