Excessive visceral fat area as a risk factor for early postoperative complications of total gastrectomy for gastric cancer: a retrospective cohort study

Abstract

BackgroundObesity is a known risk factor for complications after digestive surgery. Body mass index (BMI) is commonly used as an index of obesity but does not always reflect the degree of obesity. Although some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. In this study, we demonstrated that VFA is more useful than BMI in predicting complications after total gastrectomy.MethodsSeventy-five patients who underwent total gastrectomy for gastric cancer were enrolled in this study; they were divided into two groups: a high-VFA group (n = 26, ≥100 cm2) and a low-VFA group (n = 49, <100 cm2). We retrospectively evaluated the preoperative characteristics and surgical outcomes of all patients and examined postoperative complications within 30 days of surgery (including cardiac complications, pneumonia, ileus, anastomotic leakage, pancreatic fistula, incisional surgical site infection [SSI], abdominal abscess, and hemorrhage).ResultsThe incidence of anastomotic leakage (p = 0.03) and incisional SSI (p = 0.001) were higher in the high-VFA group than in the low-VFA group. No significant differences were observed in the other factors. We used univariate analysis to identify risk factors for anastomotic leakage and incisional SSI. Age and VFA were risk factors for anastomotic leakage, and BMI and VFA were risk factors for incisional SSI. A multivariate analysis including these factors found that only VFA was a predictor of anastomotic leakage (hazard ratio [HR] 4.62; 95 % confidence interval [CI] 1.02–21.02; p = 0.048) and incisional SSI (HR 4.32; 95 % CI 1.18–15.80; p = 0.027].ConclusionsHigh VFA is more useful than BMI in predicting anastomotic leakage and SSI after total gastrectomy. Therefore, we should consider the VFA value during surgery

Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

“…This effect could improve glucose control postoperatively, which has been demonstrated to reduce the risk of infectious complications. The higher rate of complications associated with obesity in surgery for gastric cancer is mainly attributed to an increase in the rate of surgical‐site infections . The significantly reduced HbA1c concentration in our study supports the concept that preoperative weight loss programs may reduce postoperative infectious complications.…”

“…Much of the research on surgical treatment of gastric cancer has focused on obesity in recent years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Obesity is associated with increased blood loss, a prolonged operative time, a high rate of postoperative complications, and inadequate lymph node staging.…”

Obesity as a surgical risk factor

“…This negative influence might account for the high risks of complications such as incision infection, leakage, postoperative pneumonia, and intra‐abdominal abscess . In contrast, although BMI routinely serves as an obesity index, the visceral fat area (VFA) is reportedly a more appropriate predictor of complications . Notably, VFA is often used as an obesity index for patients developing pancreatic fistula as a specific complication after gastrectomy, and an increase in VFA can serve as an important indicator of pancreatic fluid leakage risk …”

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

“…A history of such postoperative complications increases the likelihood of poor survival. The effect of body mass index (BMI) on oncological outcomes after major resection for cancer has also been investigated 20, 21, 22, 23. Although the majority of the studies show a significant association between high BMI and postoperative morbidity, the association of BMI with long‐term oncological outcomes is still controversial.…”