Implications of overweight in gastric cancer: A multicenter study in a Western patient population

Abstract

AIMS: The purpose of this study was to evaluate the effects of overweight on surgical and long-term outcomes in a Western population of patients with gastric cancer (GC).METHODS: An electronic database of all patients with resectable GC treated between 1986 and 1998 at seven university surgical centres cooperating in the Polish Gastric Cancer Study Group was reviewed. Overweight was defined as a body mass index (BMI) of 25 kg/m 2 or higher.RESULTS: Four hundred and ninety-two of 1992 (25%) patients were overweight.Postoperatively, higher BMI was associated with higher rates of cardiopulmonary complications (16% vs 12%, P=0.001) and intra-abdominal abscess (6.9% vs 2.9%, P<0.001).However, other complications and mortality rates were unaffected. The median diseasespecific survival of overweight patients was significantly higher (36.7 months, 95%confidence interval (CI) 29.0 to 44.4) than those with BMI<25 kg/m 2 (25.7 months, 95%CI23.2 to 28.1; P=0.003). These differences were due to the lower frequencies of patients with T3 and T4 tumours, metastatic lymph nodes, distant metastases, and non-curative resections.A Cox proportional hazards model identified age, depth of infiltration, lymph node metastases, distant metastases, and residual tumour category as the independent prognostic factors.CONCLUSIONS: Overweight is not the independent prognostic factor for long-term survival in a Western-type population of GC.

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

“…The difference between wound infection rates between obese (12%) and non-obese patients (8%) was not statistically significant (p = 0.28) in our patients. In accordance to our findings, Kulig et al [24] found a correlation between high BMI and high rates of cardiopulmonary complications and intraabdominal abscesses in a study on 1992 patients who underwent resection for gastric cancer. Interestingly, the median disease-specific survival of overweight patients (BMI >25) was significantly higher due to lower tumor stages in these patients, but overweight was not an independent prognostic factor for long-term survival [24] .…”

Improving the outcomes in gastric cancer surgery

“…Obese patients especially had more anastomotic leakages (11.8% vs 5.4%) and wound infections (8.9% vs 4.7%). Several other studies have also shown the association between higher BMI and increased postoperative morbidity [17][18][19] . Although no valid explanation for this finding is reported; it is suggested that in open and laparoscopic surgery, obesity is associated with more technical difficulties [20] .…”

Implications of BMI for the Prognosis of Gastric Cancer among the Japanese Population

“…For a long time, obesity has been thought to be a preoperative risk factor for surgery due to its association with numerous complications, such as cardiovascular, pulmonary and metabolic disorders, which may result in increased postoperative morbidity [3] . In addition, clinical experience indicates that the degree of obesity affects the technical difficulty of performing surgical procedures, as the operative field is deepened by the thickness of the abdominal wall and the well-developed omentum and adipose tissue around the intestinal tract in obese patients impair the extent of exposure of the operative field.…”