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Predictive Value of Body Mass Index for Short-Term Outcomes of Patients with Esophageal Cancer After Esophagectomy: A Meta-analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The association between body mass index (BMI) and short-term outcomes after esophagectomy remains controversial.

Methods

A meticulous search for articles describing the association between BMI and perioperative outcomes after esophagectomy was conducted using PubMed, EMBASE, and the Cochrane Library. The study classified BMI according to the World Health Organization definitions and Asian-specific BMI cutoff values. Normal weight was selected as the comparator, and the odds ratio (OR) was calculated as the primary effect.

Results

This meta-analysis included 13 studies with 5480 patients. Obese patients exhibited higher risks of overall complication (OR 1.37; P = 0.013), anastomotic leakage (OR 1.74; P = 0.001), and thromboembolic complications (OR 2.05; P = 0.039). Subgroup analysis indicated that obese patients from Western countries had a higher risk of wound infection (OR 2.22; P = 0.022), whereas obese Asians were more likely to experience pulmonary complications (OR 1.64; P = 0.002). Overweight patients displayed no significant differences in major complications relative to normal-weight patients, except for the increased risk of overall complications (OR 1.32; P = 0.030). Additionally, underweight patients showed increased incidence of pulmonary complications (OR 1.92; P = 0.020 and anastomotic leakage (OR 1.64; P = 0.034). Morbid obesity also was analyzed separately with limited data, and this group displayed a higher risk of wound infection (OR 1.62; P = 0.027) and thromboembolic complications (OR 2.65; P = 0.003). No significant differences in mortality were observed among patients in different BMI categories.

Conclusions

Obesity and underweight statuses were confirmed risk factors for several complications after esophagectomy, whereas overweight patients tended to experience greater benefit from surgery.

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Acknowledgment

We thank M. K. Ferguson (Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA) for providing advice and sharing data, and we also thank all the authors of the studies included in our article. The study was founded by the Project of Science and Technology of Henan Province (Grant No. 152102310160) and Spatiotemporal Data Analysis of Cancer Burden in China (Grant No. 2018-I2M-3-003).

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Authors and Affiliations

  1. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China

    Peiyu Wang MD, Yin Li MD, PhD, Haibo Sun MD, PhD, Shilei Liu MD, Ruixiang Zhang MD, PhD, Xianben Liu MD & Zhengshuai Zhu MD

  2. Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yin Li MD, PhD

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Correspondence to Yin Li MD, PhD.

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Wang, P., Li, Y., Sun, H. et al. Predictive Value of Body Mass Index for Short-Term Outcomes of Patients with Esophageal Cancer After Esophagectomy: A Meta-analysis. Ann Surg Oncol 26, 2090–2103 (2019). https://doi.org/10.1245/s10434-019-07331-w

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