Skip to main content
SpringerLink
Log in

Impact of Body Mass Index on Postoperative Outcome of Advanced Gastric Cancer After Curative Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The impact of body mass index (BMI) on the outcome of advanced gastric cancer surgery is controversial. Between December 1987 and December 2006, a total of 947 advanced gastric cancer patients receiving curative resection with retrieved lymph node number >15 were studied and divided into three groups according to BMI (<25, 25–30, and >30 kg/m2).

Results and Discussion

With regard to comorbidities present prior to surgery, higher BMI patients were more likely to have heart disease, type 2 diabetes, and hypertension than lower BMI patients. Compared with BMI <25 kg/m2, higher BMI patients had longer operative time and more surgery-related morbidity. Multivariate Cox proportional-hazard analysis showed that age, pathological T and N categories, and lymphovascular invasion were independent prognostic factors. The initial recurrence patterns, 5-year overall survival, and cancer-specific survival were similar among the three groups.

Conclusion

Only in stage III gastric cancer with BMI less than 25 kg/m2 patients receiving total gastrectomy had a more advanced pathological N category and a worse prognosis compared to those receiving subtotal gastrectomy. Higher BMI was associated with longer operative time and more surgery-related morbidity than lower BMI. BMI alone is not an independent prognostic factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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; 371:569–578.

    Article  PubMed  Google Scholar 

  2. Yang P, Zhou Y, Chen B, Wan HW, Jia GQ, Bai HL, Wu XT. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer 2009; 45: 2867–2873.

    Article  PubMed  Google Scholar 

  3. Kodera Y, Ito S, Yamamura Y, Mochizuki Y, Fujiwara M, Hibi K, Ito K, Akiyama S, Nakao A. Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology 2004; 51: 1225–1228.

    PubMed  Google Scholar 

  4. 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: 141–144.

    Article  PubMed  Google Scholar 

  5. Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, Kohno H, Nagasue N. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 2000; 59: 18–23.

    Article  PubMed  CAS  Google Scholar 

  6. Barry JD, Blackshaw GR, Edwards P, Lewis WG, Murphy P, Hodzovic I, Thompson IW, Allison MC. Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma. Gastric Cancer 2003; 6: 80–85.

    PubMed  Google Scholar 

  7. Moriwaki Y, Kunisaki C, Kobayashi S, Harada H, Imai S, Kasaoka C. Does body mass index (BMI) influence morbidity and long-term survival in gastric cancer patients after gastrectomy? Hepatogastroenterology 2003; 50: 284–288.

    PubMed  Google Scholar 

  8. Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, Kurita A, Katai H, Shimizu T, Furukawa H, Inoue S, Hiratsuka M, Kinoshita T, Arai K, Yamamura Y; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extensive para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol 2007; 14: 355–361.

    Article  PubMed  Google Scholar 

  9. Kulig J, Sierzega M, Kolodziejczyk P, Dadan J, Drews M, Fraczek M, Jeziorski A, Krawczyk M, Starzynska T, Wallner G; Polish Gastric Cancer Study Group. Implications of overweight in gastric cancer: a multicenter study in a Western patient population. Eur J Surg Oncol 2010; 36: 969–976.

    Article  PubMed  CAS  Google Scholar 

  10. 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: 363–368.

    Article  PubMed  Google Scholar 

  11. 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: 3245–3251.

    Article  PubMed  Google Scholar 

  12. Oh SJ, Hyung WJ, Li C, Song J, Rha SY, Chung HC, Choi SH, Noh SH. Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma. J Gastroenterol Hepatol 2009; 24: 475–479.

    Article  PubMed  Google Scholar 

  13. Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC, Li AF, Chiou SH, Wu CW. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg. 2012; 16(7):1303–10.

    Article  PubMed  Google Scholar 

  14. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 Jan;26 Suppl 1:S5–20.

  15. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC Jr, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK; American College of Cardiology Foundation/American Heart Asscoiation Tasl Force on Practice Guidelines. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010 21;122(25):2748–64. doi:10.1161/CIR.0b013e3182051bab. Epub 2010 Nov 15.

  16. Whitworth JA; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003 ;21(11):1983–92.

    Google Scholar 

  17. Sobin L GM, Wittekind C, eds. TNM Classification of Malignant Tumours In: 7th ed. International Union Against Cancer (UICC). New York: Wiley, 2009.

  18. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K; ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007; 357: 1810–1820.

    Article  PubMed  CAS  Google Scholar 

  19. Wu CW, Lo SS, Shen KH, Hsieh MC, Chen JH, Chiang JH, Lin HJ, Li AF, Lui WY. Incidence and factors associated with recurrence patterns after intended curative surgery for gastric cancer. World J Surg 2003; 27: 153–158.

    PubMed  Google Scholar 

  20. Freeman JB, Meyer PD, Printen KJ, Mason EE, DenBesten L. Analysis of gallbladder bile in morbid obesity. Am J Surg 1975; 129: 163–166.

    Article  PubMed  CAS  Google Scholar 

  21. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347: 995–999.

    Article  PubMed  CAS  Google Scholar 

  22. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345: 745–748.

    Article  PubMed  CAS  Google Scholar 

  23. Nomura E, Sasako M, Yamamoto S, Sano T, Tsujinaka T, Kinoshita T, Furukawa H, Shimizu T, Hiratsuka M, Kobayashi O, Kurokawa Y, Tanigawa N; Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group. Risk factors for para-aortic lymph node metastasis of gastric cancer from a randomized controlled trial of JCOG9501. Jpn J Clin Oncol 2007; 37: 429–433.

    Article  PubMed  Google Scholar 

  24. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Lui WY, Whang-Peng J. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006; 7: 309–315.

    Article  PubMed  CAS  Google Scholar 

  25. Siewert JR, Bottcher K, Stein HJ, Roder JD, Busch R. Problem of proximal third gastric carcinoma. World J Surg 1995;19: 523–531.

    Article  PubMed  CAS  Google Scholar 

  26. Piso P, Werner U, Lang H, Mirena P, Klempnauer J. Proximal versus distal gastric carcinoma-what are the differences? Ann Surg Oncol 2000;7:520–525.

    Article  PubMed  CAS  Google Scholar 

  27. Tsou CC, Lo SS, Fang WL, Wu CW, Chen JH, Hsieh MC, Shen KH. Risk factors and management of anastomotic leakage after radical gastrectomy for gastric cancer. Hepatogastroenterology 2011; 58: 218–223.

    PubMed  Google Scholar 

  28. Lo CH, Chen JH, Wu CW, Lo SS, Hsieh MC, Lui WY. Risk factors and management of intra-abdominal infection after extensive radical gastrectomy. Am J Surg 2008; 196: 741–745.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Center of Excellence for Cancer Research at Taipei Veterans General Hospital (DOH102-TD-C-111-007).

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, 11217, Taiwan

    Yen-Shu Lin, Kuo-Hung Huang, Wen-Liang Fang & Chew-Wun Wu

  2. Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Yuan-Tzu Lan

  3. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

    Anna Fen-Yau Li

  4. National Yang-Ming University, Taipei, Taiwan

    Yen-Shu Lin, Jen-Hao Chen, Su-Shun Lo, Anna Fen-Yau Li & Chew-Wun Wu

  5. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Kuo-Hung Huang, Yuan-Tzu Lan, Wen-Liang Fang & Shih-Hwa Chiou

  6. En Chu Kong Hospital, New Taipei, Taiwan

    Jen-Hao Chen

  7. National Yang-Ming University Hospital, Yilan, Taiwan

    Su-Shun Lo

  8. Taipei Medical College-affiliated Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan

    Mao-Chih Hsieh

  9. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Shih-Hwa Chiou

  10. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan

    Shih-Hwa Chiou

Authors
  1. Yen-Shu Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kuo-Hung Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuan-Tzu Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wen-Liang Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jen-Hao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Su-Shun Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mao-Chih Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna Fen-Yau Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shih-Hwa Chiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chew-Wun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wen-Liang Fang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lin, YS., Huang, KH., Lan, YT. et al. Impact of Body Mass Index on Postoperative Outcome of Advanced Gastric Cancer After Curative Surgery. J Gastrointest Surg 17, 1382–1391 (2013). https://doi.org/10.1007/s11605-013-2238-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2238-x

Keywords

Search

Navigation