Abstract
Background
Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown.
Methods
Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996–2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival.
Results
Seventy-nine patients (28.3%) had primary hepatobiliary cancers, 134 (48.0%) had colorectal metastases, and 66 (25.3%) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8% vs. 15.9%, p = 0.018), bile leaks (18.6% vs. 9.9%, p = 0.030), post-operative pneumonia (9.3% vs. 2.2%, p = 0.0074), intra-abdominal abscesses (7.2% vs. 1.7%, p = 0.017), acute renal failure (7.2% vs. 1.7%, p = 0.017), urinary tract infections (16.4% vs. 7.7%, p = 0.024), and longer lengths of stay (10.5 vs.8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95% CI 0.86–0.95) and overall survival (HR 0.96, 95% CI 0.92–0.99).
Conclusions
High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.
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References
Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology 2007;132(6):2087–2102.
Pitt HA. Hepato-pancreato-biliary fat: the good, the bad and the ugly. HPB (Oxford) 2007;9(2):92–97.
Renehan AG, Roberts DL, Dive C. Obesity and cancer: pathophysiological and biological mechanisms. Arch Physiol Biochem 2008;114(1):71–83.
Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371(9612):569–578.
Gedaly R, McHugh PP, Johnston TD, Jeon H, Ranjan D, Davenport DL. Obesity, diabetes, and smoking are important determinants of resource utilization in liver resection: a multicenter analysis of 1029 patients. Ann Surg 2009;249(3):414–419.
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(9):2565–2569.
Utsunomiya T, Okamoto M, Kameyama T, Matsuyama A, Yamamoto M, Fujiwara M et al. Impact of obesity on the surgical outcome following repeat hepatic resection in Japanese patients with recurrent hepatocellular carcinoma. World J Gastroenterol 2008;14(10):1553–1558.
Mullen JT, Davenport DL, Hutter MM, Hosokawa PW, Henderson WG, Khuri SF et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008;15(8):2164–2172.
Ryan CK, Johnson LA, Germin BI, Marcos A. One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl 2002;8(12):1114–1122.
Kooby DA, Fong Y, Suriawinata A, Gonen M, Allen PJ, Klimstra DS et al. Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg 2003;7(8):1034–1044.
Mathur A, Zyromski NJ, Pitt HA, Al-Azzawi H, Walker JJ, Saxena R et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer. J Am Coll Surg 2009;208(5):989–994; discussion 994–986.
Fleming JB, Gonzalez RJ, Petzel MQ, Lin E, Morris JS, Gomez H et al. Influence of obesity on cancer-related outcomes after pancreatectomy to treat pancreatic adenocarcinoma. Arch Surg 2009;144(3):216–221.
Larsson SC, Wolk A. Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies. Br J Cancer 2007;97(7):1005–1008.
Larsson SC, Wolk A. Obesity and the risk of gallbladder cancer: a meta-analysis. Br J Cancer 2007;96(9):1457–1461.
House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008;12(2):270–278.
Behrns KE, Tsiotos GG, DeSouza NF, Krishna MK, Ludwig J, Nagorney DM. Hepatic steatosis as a potential risk factor for major hepatic resection. J Gastrointest Surg 1998;2(3):292–298.
Schrader AJ, Rustemeier J, Rustemeier JC, Timmesfeld N, Varga Z, Hegele A et al. Overweight is associated with improved cancer-specific survival in patients with organ-confined renal cell carcinoma. J Cancer Res Clin Oncol 2009.
Haferkamp A, Pritsch M, Bedke J, Wagener N, Pfitzenmaier J, Buse S et al. The influence of body mass index on the long-term survival of patients with renal cell carcinoma after tumour nephrectomy. BJU Int 2008;101(10):1243–1246.
Ogino S, Nosho K, Baba Y, Kure S, Shima K, Irahara N et al. A Cohort Study of STMN1 Expression in Colorectal Cancer: Body Mass Index and Prognosis. Am J Gastroenterol 2009.
Ogino S, Shima K, Nosho K, Irahara N, Baba Y, Wolpin BM et al. A cohort study of p27 localization in colon cancer, body mass index, and patient survival. Cancer Epidemiol Biomarkers Prev 2009;18(6):1849–1858.
Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, Nelson H et al. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage III colon cancer: findings from Cancer and Leukemia Group B 89803. J Clin Oncol 2008;26(25):4109–4115.
Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, McCollum AD, Brady D et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol 2004;22(4):648–657.
Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB, 3rd, Macdonald JS et al. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 2003;98(3):484–495.
Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O’Connell MJ et al. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 2006;98(22):1647–1654.
Miyake K, Hayakawa K, Nishino M, Morimoto T, Mukaihara S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. Acad Radiol 2005;12(6):722–727.
He S, Atkinson C, Evans Z, Ellett JD, Southwood M, Elvington A et al. A role for complement in the enhanced susceptibility of steatotic livers to ischemia and reperfusion injury. J Immunol 2009;183(7):4764–4772.
He S, Atkinson C, Qiao F, Cianflone K, Chen X, Tomlinson S. A complement-dependent balance between hepatic ischemia/reperfusion injury and liver regeneration in mice. J Clin Invest 2009;119(8):2304–2316.
Gao F, Xu X, Ling Q, Wu J, Zhou L, Xie HY et al. Efficacy and safety of moderately steatotic donor liver in transplantation. Hepatobiliary Pancreat Dis Int 2009;8(1):29–33.
Gomez D, Malik HZ, Bonney GK, Wong V, Toogood GJ, Lodge JP et al. Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastasis. Br J Surg 2007;94(11):1395–1402.
Vetelainen R, Bennink RJ, van Vliet AK, van Gulik TM. Mild steatosis impairs functional recovery after liver resection in an experimental model. Br J Surg 2007;94(8):1002–1008.
Aloia T, Sebagh M, Plasse M, Karam V, Levi F, Giacchetti S et al. Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006;24(31):4983–4990.
El-Badry AM, Breitenstein S, Jochum W, Washington K, Paradis V, Rubbia-Brandt L et al. Assessment of Hepatic Steatosis by Expert Pathologists: The End of a Gold Standard. Ann Surg 2009; 250(5);691–697.
Acknowledgment
AKM and AAG are supported by a NIH/NRSA T32 training grant #F015873.
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Mathur, A.K., Ghaferi, A.A., Sell, K. et al. Influence of Body Mass Index on Complications and Oncologic Outcomes Following Hepatectomy for Malignancy. J Gastrointest Surg 14, 849–857 (2010). https://doi.org/10.1007/s11605-010-1163-5
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DOI: https://doi.org/10.1007/s11605-010-1163-5