World Journal of Surgery

, Volume 37, Issue 5, pp 1072–1081

Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over-D1” Lymphadenectomy for Gastric Cancer

  • Giacomo Pata
  • Leonardo Solaini
  • Stefano Roncali
  • Mario Pasini
  • Fulvio Ragni
Article

Abstract

Introduction

The purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with “over-D1” dissection for gastric cancer.

Methods

Data on 161 patients undergoing total gastrectomy between 2005 and 2011 were reviewed. Patients were grouped into three categories by BMI: BMI < 25 kg/m2 (63 normal-weight patients; 39.1 %), BMI ≥ 25–<30 kg/m2 (73 overweight patients; 45.3 %), and BMI ≥ 30 kg/m2 (25 obese patients; 15.6 %) and matched for the analysis of perioperative and cancer-related outcomes.

Results

Operative time was longer for obese patients. Medical (mainly pulmonary) and surgical (mainly bleeding and wound infection) complications occurred more frequently in overweight/obese subjects. However, they were mostly managed conservatively (grade I–II in the Clavien-Dindo classification). The overall postoperative mortality was 0.9 %. Multivariate analysis identified the American Society of Anesthesiologists score and splenectomy, but not obesity, as independent risk factors for postoperative complications. The median number of lymph nodes retrieved differed significantly from group to group: obese 21 (IQR 18–26), versus overweight 24, versus normal weight 28 (p = 0.031). No difference was found in lymph node ratio and cancer-related parameters.

Conclusions

Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.

References

  1. 1.
    World Health Organization (2012) Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed 1 April 2012
  2. 2.
    Calle EE, Rodriguez C, Walker-Thurmond K et al (2003) Overweight, obesity, and mortality from cancer in a prospective studied cohort of US adults. N Engl J Med 348:1625–1638PubMedCrossRefGoogle Scholar
  3. 3.
    Nock NL, Thompson CL, Tucker TC et al (2008) Associations between obesity and changes in adult BMI over time and colon cancer risk. Obesity (Silver Spring) 16:1099–1104CrossRefGoogle Scholar
  4. 4.
    Giovannucci E, Michaud D (2007) The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 132:2208–2225PubMedCrossRefGoogle Scholar
  5. 5.
    Kojima M, Wakai K, Tamakoshi K, JACC Study Group et al (2004) A prospective study of body size and colon cancer mortality in Japan: the JACC study. Int J Obes Relat Metab Disord 28:551–558PubMedCrossRefGoogle Scholar
  6. 6.
    Lindblad M, Rodríguez LA, Lagergren J (2005) Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric noncardia adenocarcinoma among men and women in a nested case control study. Cancer Causes Control 16:285–294PubMedCrossRefGoogle Scholar
  7. 7.
    Lagergren J, Bergström R, Nyrén O (1999) Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 130:883–890PubMedGoogle Scholar
  8. 8.
    Kodera Y, Sasako M, Yamamoto S et al (2005) Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92:1103–1109PubMedCrossRefGoogle Scholar
  9. 9.
    Tsujinaka T, Sasako M, Yamamoto S et al (2007) Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended paraaortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol 14:355–361PubMedCrossRefGoogle Scholar
  10. 10.
    Moriwaki Y, Kunisaki C, Kobayashi S et al (2003) Does body mass index (BMI) influence morbidity and long-term survival in gastric cancer patients after gastrectomy? Hepatogastroenterology 50:284–288PubMedGoogle Scholar
  11. 11.
    Dhar DK, Kubota H, Tachibana M et al (2000) Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 59:18–23PubMedCrossRefGoogle Scholar
  12. 12.
    Kodera Y, Ito S, Yamamura Y et al (2004) Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology 51:1225–1228PubMedGoogle Scholar
  13. 13.
    Inagawa S, Adachi S, Oda T et al (2000) Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer 3:141–144PubMedCrossRefGoogle Scholar
  14. 14.
    Gretschel S, Christoph F, Bembenek A et al (2003) Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol 10:363–368PubMedCrossRefGoogle Scholar
  15. 15.
  16. 16.
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  18. 18.
    Washington K (2010) 7th Edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079PubMedCrossRefGoogle Scholar
  19. 19.
    Cuschieri A, Weeden S, Fielding J et al (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical co-operative group. Br J Cancer 79:1522–1530PubMedCrossRefGoogle Scholar
  20. 20.
    Cuschieri A, Fayers P, Fielding J et al (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The surgical cooperative group. Lancet 347:995–999PubMedCrossRefGoogle Scholar
  21. 21.
    Hartgrink HH, van de Velde CJ, Putter H et al (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22:2069–2077PubMedCrossRefGoogle Scholar
  22. 22.
    Bonenkamp JJ, Songun I, Hermans J et al (1995) Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748PubMedCrossRefGoogle Scholar
  23. 23.
    Edwards P, Blackshaw PG, Barry J (2003) Randomized comparison of D1 versus modified D2 gastrectomy for gastric cancer. Br J Surg 90(Suppl 1):1888–1892Google Scholar
  24. 24.
    Jansen EPM, Boot H, Verheij M et al (2005) Optimal locoregional treatment in gastric cancer. J Clin Oncol 23:4509–4517PubMedCrossRefGoogle Scholar
  25. 25.
    Lee JH, Paik YH, Lee JS et al (2007) Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 14:1288–1294PubMedCrossRefGoogle Scholar
  26. 26.
    Sugisawa N, Tokunaga M, Tanizawa Y et al (2012) Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat. Gastric Cancer 15:206–212PubMedCrossRefGoogle Scholar
  27. 27.
    Nobuoka D, Gotohda N, Kato Y et al (2011) Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today 41:928–934PubMedCrossRefGoogle Scholar
  28. 28.
    Ojima T, Iwahashi M, Nakamori M et al (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg 144:351–358PubMedCrossRefGoogle Scholar
  29. 29.
    Oh SJ, Hyung WJ, Li C et al (2009) Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J Gastroenterol Hepatol 24:475–479PubMedCrossRefGoogle Scholar
  30. 30.
    Tokunaga M, Hiki N, Fukunaga T et al (2009) Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg 96:496–500PubMedCrossRefGoogle Scholar
  31. 31.
    Tanaka K, Miyashiro I, Yano M et al (2009) Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy. Ann Surg Oncol 16:1520–1525PubMedCrossRefGoogle Scholar
  32. 32.
    Mariette C, Castel B, Toursel H et al (2002) Surgical management and long-term survival after adenocarcinoma of the cardia. Br J Surg 89:1156–1163PubMedCrossRefGoogle Scholar
  33. 33.
    Ichikura T, Chochi K, Sugasawa H et al (2005) Modified radical lymphadenectomy (D1.5) for T2–3 gastric cancer. Langenbecks Arch Surg 390:397–402PubMedCrossRefGoogle Scholar
  34. 34.
    Mullaney PJ, Wadley MS, Hyde C et al (2002) Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer. Union international Contra la Cancrum/American joint committee on cancer. Br J Surg 89:1405–1408PubMedCrossRefGoogle Scholar
  35. 35.
    Wang J, Dang P, Raut CP et al (2012) Comparison of a lymph node ratio-based staging system with the 7th AJCC system for gastric cancer: analysis of 18,043 patients from the SEER database. Ann Surg 255:478–485PubMedCrossRefGoogle Scholar
  36. 36.
    Seidell JC, Flegal KM (1997) Assessing obesity: classification and epidemiology. Br Med Bull 53:238–252PubMedCrossRefGoogle Scholar
  37. 37.
    Kuczmarski RJ, Flegal KM, Campbell SM et al (1994) Increasing prevalence of overweight among US adults. The national health and nutrition examination surveys, 1960 to 1991. J Am Med Assoc 272:205–211CrossRefGoogle Scholar
  38. 38.
    Jee SH, Sull JW, Park J et al (2006) Body-mass index and mortality in Korean men and women. N Engl J Med 355:779–787PubMedCrossRefGoogle Scholar
  39. 39.
    Nobuoka D, Gotohda N, Konishi M et al (2008) Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg 32:2261. doi:10.1007/s00268-008-9683-9s PubMedCrossRefGoogle Scholar
  40. 40.
    Noguchi Y, Yoshikawa T, Tsuburaya A et al (2000) Is gastric carcinoma different between Japan and the United States? Cancer 89:2237–2246PubMedCrossRefGoogle Scholar
  41. 41.
    Gockel I, Pietzka S, Gönner U et al (2005) Subtotal or total gastrectomy for gastric cancer: impact of the surgical procedure on morbidity and prognosis—analysis of a 10-year experience. Langenbecks Arch Surg 390:148–155PubMedCrossRefGoogle Scholar
  42. 42.
    Otsuji E, Fujiyama J, Takagi T et al (2005) Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients. J Surg Oncol 91:232–236PubMedCrossRefGoogle Scholar
  43. 43.
    Degiuli M, Sasako M, Ponzetto A et al (1997) Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases. Eur J Surg Oncol 23:310–314PubMedCrossRefGoogle Scholar
  44. 44.
    Oh SJ, Choi WB, Song J, Yonsei Gastric Cancer Clinic et al (2009) Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg 13:239–245PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Giacomo Pata
    • 1
  • Leonardo Solaini
    • 2
  • Stefano Roncali
    • 1
  • Mario Pasini
    • 1
  • Fulvio Ragni
    • 1
  1. 1.2nd Division of General Surgery, Department of Medical and Surgical SciencesBrescia Civic HospitalBresciaItaly
  2. 2.2nd Division of General Surgery, Department of Medical and Surgical SciencesUniversity of Brescia School of MedicineBresciaItaly

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