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Annals of Surgical Oncology

, Volume 20, Issue 3, pp 780–787 | Cite as

Impact of Obesity on Perioperative Complications and Long-term Survival of Patients with Gastric Cancer

  • Kai A. Bickenbach
  • Brian Denton
  • Mithat Gonen
  • Murray F. Brennan
  • Daniel G. Coit
  • Vivian E. StrongEmail author
Gastrointestinal Oncology

Abstract

Background

The prevalence of obesity is increasing in the United States. Obesity has been associated with worse surgical outcomes, but its impact on long-term outcomes in gastric cancer is unclear. The aim of this study was to evaluate the effects of being overweight on surgical and long-term outcomes for patients with gastric cancer.

Methods

Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2007 were identified from a prospectively collected gastric cancer database. Overweight was defined as a body mass index (BMI) of 25 kg/m2 or higher. Clinical outcomes of overweight and nonoverweight patients were compared.

Results

From the total population of 1,853 patients, 1,125 (60.7 %) were overweight. Overweight patients tended to have more proximal tumors and a lower T stage. Accurate complication data were available on a subset of patients from 2000 to 2007. A BMI of ≥25 was associated with increased postoperative complications (47.9 vs. 35.8 %, p < 0.001). This was mainly due to an increase in the rate of wound infections (8.9 vs. 4.7 %, p = 0.02) and anastomotic leaks (11.8 vs. 5.4 %, p = 0.002). Multivariate logistic regression analysis showed that higher BMI, total gastrectomy, and use of neoadjuvant chemotherapy were associated with increased wound infection and anastomotic leak. Overweight patients were less likely to have adequate lymph node staging (73.3 vs. 79.2 %, p = 0.047). There was no difference in overall survival or disease-specific survival between the two groups.

Conclusions

Increased BMI is a predictor of increased postoperative complications, including anastomotic leak, but it is not a predictor of survival in gastric cancer.

Keywords

Body Mass Index Gastric Cancer Overall Survival Anastomotic Leak High Body Mass Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

There is no conflicts of interest.

References

  1. 1.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among U.S. adults, 1999–2008. JAMA. 2010;303:235–41.PubMedCrossRefGoogle Scholar
  3. 3.
    National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med. 2000;160:898–904.Google Scholar
  4. 4.
    Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Boggs DA, Rosenberg L, Cozier YC, et al. General and abdominal obesity and risk of death among black women. N Engl J Med. 2011;365:901–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Boffetta P, McLerran D, Chen Y, et al. Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the Asia cohort consortium. PLoS One. 2011;6:e19930.PubMedCrossRefGoogle Scholar
  7. 7.
    Benns M, Woodall C, Scoggins C, McMasters K, Martin R. The impact of obesity on outcomes following pancreatectomy for malignancy. Ann Surg Oncol. 2009;16:2565–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero JR. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23:1460–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Chern H, Chou J, Donkor C, et al. Effects of obesity in rectal cancer surgery. J Am Coll Surg. 2010;211:55–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Kunisaki C, Makino H, Takagawa R, et al. Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc. 2009;23:2085–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Tsujinaka T, Sasako M, Yamamoto S, 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;14:355–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Kodera Y, Sasako M, Yamamoto S, et al. Identification of risk factors for the development of complications following extended and super-extended lymphadenectomies for gastric cancer. Br J Surg. 2005;92:1103–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee HJ, Kim HH, Kim MC, et al. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc. 2009;23:2473–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Kulig J, Sierzega M, Kolodziejczyk P, et al. Implications of overweight in gastric cancer: a multicenter study in a Western patient population. Eur J Surg Oncol. 2010;36:969–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Dhar DK, Kubota H, Tachibana M, 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol. 2003;10:363–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Kodera Y, Ito S, Yamamura Y, et al. Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology. 2004;51:1225–8.PubMedGoogle Scholar
  19. 19.
    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;16:3245–51.PubMedCrossRefGoogle Scholar
  20. 20.
    American Joint Committee on Cancer. Cancer staging manual. 7th ed. Chicago: Springer; 2010.Google Scholar
  21. 21.
    Rüdiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000;232:353–61.PubMedCrossRefGoogle Scholar
  22. 22.
    World Health Organization. Global data on body mass index. BMI classification. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 2 Feb 2011.
  23. 23.
    Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–64.PubMedCrossRefGoogle Scholar
  24. 24.
    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;3:141–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Chow WH, Blot WJ, Vaughan TL, et al. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1998;90:150–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med. 1999;130:883–90.PubMedGoogle Scholar
  27. 27.
    Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 1995;4:85–92.PubMedGoogle Scholar
  28. 28.
    Kattan MW, Karpeh MS, Mazumdar M, Brennan MF. Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol. 2003;21:3647–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Barbour AP, Rizk NP, Gonen M, et al. Lymphadenectomy for adenocarcinoma of the gastroesophageal junction (GEJ): impact of adequate staging on outcome. Ann Surg Oncol. 2007;14:306–16.PubMedCrossRefGoogle Scholar
  31. 31.
    Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than number? An analysis of 1,038 patients. Ann Surg. 2000;232:362–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Ojima T, Iwahashi M, Nakamori M, et al. 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. 2009;144:351–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Oh SJ, Hyung WJ, Li C, et al. Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J Gastroenterol Hepatol. 2009;24:475–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Ahmed D, Cheema FH, Ahmed YI, et al. Incidence and predictors of infection in patients undergoing primary isolated coronary artery bypass grafting: a report from a tertiary care hospital in a developing country. J Cardiovasc Surg (Torino). 2011;52:99–104.Google Scholar
  35. 35.
    Turtiainen J, Saimanen E, Partio T, et al. Surgical wound infections after vascular surgery: prospective multicenter observational study. Scand J Surg. 2010;99:167–72.PubMedGoogle Scholar
  36. 36.
    House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239:599–605.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Kai A. Bickenbach
    • 1
  • Brian Denton
    • 2
  • Mithat Gonen
    • 2
  • Murray F. Brennan
    • 1
  • Daniel G. Coit
    • 1
  • Vivian E. Strong
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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