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Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

This study aimed to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.

Methods

We conducted a prospective study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy. Degrees of sarcopenia and obesity were calculated before surgery. Factors contributing to SPCs were determined using univariate and multivariate analysis. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.

Results

Logistic analysis revealed that sarcopenic obesity, age, open surgery, and combined resection were independent prognostic factors for SPCs. Sarcopenic obese patients have the highest risk in all patients (sarcopenic obesity vs normal, OR = 6.575 p = 0.001; sarcopenic obesity vs obesity, OR = 5.833 p = 0.001; sarcopenic obesity vs sarcopenia, OR = 2.571 p = 0.032), while obese patients share the similar rate of SPCs with normal people (obesity vs normal, OR = 1.056 p = 0.723). The nomogram we constructed was able to quantify the risk of SPCs reliably (c-index, 0.737).

Conclusions

Sarcopenic obesity, together with age, open surgery, and combined resection are independent predictors of SPCs. Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer, but it will not bring higher risk to normal patients. Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications.

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Funding

This study was funded by the Department of Health of Zhejiang Province, China (grant no. 2016DTA006) and the Wenzhou Municipal Science and Technology Bureau (grant no. Y20150057). There are no other commercial interests or sources of financial or material support to declare.

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Author notes

  1. Wei-teng Zhang and Ji Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, ShangCai Village, Wenzhou, Zhejiang Province, China

    Wei-teng Zhang, Ji Lin, Wei-sheng Chen, Yun-shi Huang, Rui-sen Wu, Xiao-dong Chen, Neng Lou, Chu-huai Chi, Chang-yuan Hu & Xian Shen

  2. Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China

    Xian Shen

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  1. Wei-teng Zhang
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  2. Ji Lin
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  3. Wei-sheng Chen
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  4. Yun-shi Huang
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  9. Chang-yuan Hu
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Contributions

Zhang Weiteng and Lin Ji: designed the study, acquired data, analyzed, and interpreted the data, and drafted the manuscript; Chen Weisheng, Huang Yunshi, and Wu Ruisen: acquired data and carried out the statistical analysis; Chen Xiaodong, Lou neng, and Chi Chuhuai: analyzed and interpreted the data, and revised the manuscript; Hu Changyuan: designed the study, analyzed, and interpreted the data, supervised the study, revised the manuscript, and approved the version of the manuscript for publication; Shen Xian: contributed toward the conception of the study, designed the study, analyzed, and interpreted the data, revised the manuscript, and finally approved the version of the manuscript for publication.

Corresponding authors

Correspondence to Chang-yuan Hu or Xian Shen.

Ethics declarations

The study was approved by the ethics committee of the First Affiliated Hospital of Wenzhou Medical University and conformed to the tenets of the Declaration of Helsinki; all participants provided written informed consent before participating in the study.

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Zhang, Wt., Lin, J., Chen, Ws. et al. Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study. J Gastrointest Surg 22, 1861–1869 (2018). https://doi.org/10.1007/s11605-018-3835-5

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