Body Mass Index Determines the Success of Lymph Node Dissection and Predicts the Outcome of Gastric Carcinoma Patients

Dhar, Dipok Kumar; Kubota, Hirofumi; Tachibana, Mitsuo; Kotoh, Tsukasa; Tabara, Hideki; Masunaga, Reiko; Kohno, Hitoshi; Nagasue, Naofumi

doi:10.1159/000012131

Cited by 142 publications

(146 citation statements)

References 16 publications

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“…Some studies have reported the effect of obesity on open gastric cancer surgery. The Japanese studies by Inagawa et al [15] and Dhar et al [11] have shown that obesity may cause an increased rate of postoperative complications and a poor prognosis. In contrast, other studies, done in Europe by Gretschel et al [16] and Barry et al [17], have shown that obesity does not affect postoperative complications, nor does it lead to a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

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The impact of obesity on LADG for early gastric cancer

Kim

Jung

et al. 2006

Gastric Cancer

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Section: Discussionmentioning

confidence: 99%

“…A recent report from Japan concluded that a higher BMI hampered the performance of lymphadenectomy during gastric cancer surgery, and a higher BMI was reported as an independent predictor of cancer recurrence [11]. However, there are only a few studies of the relationship between obesity and laparoscopy-assisted radical gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

The impact of obesity on LADG for early gastric cancer

Kim

Jung

et al. 2006

Gastric Cancer

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“…For example, in the Japan Clinical Oncology Group (JCOG) 9501 study, which compared D2 and D2 plus para-aortic LN dissections among gastric cancer patients, only obesity and age were identified as significant patient-related factors associated with major surgical complications [6,18]. Many largescale studies have repeatedly demonstrated that obesity influences surgical outcomes after gastric cancer surgery [7,[19][20][21]. Conversely, studies focusing on LAG have shown that obesity does not increase surgical morbidity [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Lee

Kim

et al. 2009

Surg Endosc

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Background Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. Methods The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI C 25 kg/m 2 ; n = 432) and low BMI (BMI \25 kg/ m 2 ; n = 1,053) groups, and their clinical outcomes were compared. Results The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p \ 0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. Conclusions High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

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“…We have subsequently demonstrated that similar results can be achieved in a large British district general hospital Barry et al, 2003). Despite these favourable reports, there remains a widely held assumption, that poor outcomes after surgery for gastric cancer in Britain are due to the greater age, comorbidity, advanced stages of disease and greater body mass indices of Western patients when compared with their Japanese counterparts (Dhar et al, 2000). Furthermore, most oesophagogastric cancer surgery in Britain and much of the West, has by tradition, been performed by general surgeons.…”

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Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

et al. 2004

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To compare the outcomes after D1 gastrectomy with those after modified D2 gastrectomy (preserving pancreas and spleen) performed by specialist surgeons for gastric cancer in a large UK NHS Trust. In all, 118 consecutive patients with gastric adenocarcinoma were referred by postcode, to undergo either a D1 gastrectomy (North Gwent (RJ), n ¼ 36, median age 76 years, 21 m) or a modified D2 gastrectomy (South Gwent (WL), n ¼ 82, 70 years, 57 m). Operative mortality in the two groups of patients was similar (D1 8.3% vs D2 7.3%, w 2 0.286, DF 1, P ¼ 0.593). Overall cumulative survival at 5 years was 32% after D1 gastrectomy compared to 59% after D2 gastrectomy (w 2 4.25, DF 1, P ¼ 0.0392). In patients with stage III cancers, survival was 8% after D1, compared with 33% after D2 gastrectomy (w 2 6.43, DF 1, P ¼ 0.0112). In a multivariate analysis, T stage (hazard ratio 2.339, 95% CI 1.683 -2.995, P ¼ 0.01), N stage (hazard ratio 4.026, 95% CI 3.536 -4.516, P ¼ 0.0001) and the extent of lymphadenectomy (hazard ratio 0.258, 95% CI -0.426 -0.942, P ¼ 0.0001) were independently associated with durations of survival. In conclusion, modified D2 gastrectomy can improve survival four-fold for patients with stage III gastric cancer, without significantly increasing morbidity and mortality when compared with a D1 gastrectomy. Opinion over the optimum resection for patients with gastric cancer remains divided, and the literature polarised. The impressive outcomes after D2 gastrectomy published in large retrospective series from Japan (Soga et al, 1979;Maruyama et al, 1987) have not been reproduced in randomised comparative studies from Europe (Bonenkamp et al, 1995(Bonenkamp et al, , 1999Cuschieri et al, 1996Cuschieri et al, , 1999. The two largest randomised studies both report significantly greater operative morbidity and mortality associated with an extended D2 lymphadenectomy when compared with the less aggressive D1 lymphadenectomy, and have failed to demonstrate any survival advantage for a D2 resection. Many of the serious complications associated with D2 resections were associated with resections of the pancreas and spleen (Bonenkamp et al, 1995;Cuschieri et al, 1996), and the best long-term survival was observed in patients undergoing D2 gastrectomy without pancreatico-splenectomy (Cuschieri et al, 1999). Although this latter report concluded than a classical D2 resection offered no survival advantage over a D1 resection, the possibility that a modified D2 resection, preserving pancreas and spleen, might be better than a D1 resection was not dismissed (Cuschieri et al, 1999).The first reports of outcomes after modified D2 gastrectomy for gastric cancer were originally published in Britain by Sue-Ling

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Body Mass Index Determines the Success of Lymph Node Dissection and Predicts the Outcome of Gastric Carcinoma Patients

Cited by 142 publications

References 16 publications

The impact of obesity on LADG for early gastric cancer

The impact of obesity on LADG for early gastric cancer

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

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