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Sun Y, Hou L, Zhao E. Short-term outcomes of laparoscopic D2 lymphadenectomy versus D2 lymphadenectomy plus complete mesogastric excision in distal gastric cancer patients with high body mass index. BMC Cancer 2025; 25:329. [PMID: 39988653 PMCID: PMC11849342 DOI: 10.1186/s12885-025-13732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/13/2025] [Indexed: 02/25/2025] Open
Abstract
BACKGROUND The technical challenges and safety issues involving laparoscopic D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) for high body mass index (BMI) patients are still unknown. This study was conducted to compare the short-term outcomes of laparoscopic D2 + CME and D2 lymphadenectomy in distal gastric cancer patients of different BMI status. METHODS We retrospectively analyzed the data of patients with gastric cancer who underwent laparoscopic-assisted distal gastrectomy (LADG) at our center between 2019 June and 2023 September. Patients who underwent traditional laparoscopic D2 lymphadenectomy were divided into the D2 group, while patients undergoing laparoscopic D2 + CME were divided into the D2 + CME group. In each group, patients were further subdivided based on their BMI into the high BMI group (H-BMI, BMI ≥ 25) and normal BMI (N-BMI, BMI<25) group. A comparison was made between the characteristics of patients and their short-term outcomes in the two subgroups, respectively. Propensity score matching (PSM) at 1:1 ratio was performed to further assess the short-term outcomes of patients with high BMI in two groups. RESULTS AII the qualified patients were divided into the D2 group (n = 329) and D2 + CME group (n = 261). In the subgroup analysis of early surgical outcomes of the D2 group, the high BMI subgroup had longer surgery time (p = 0.007), more blood loss (p = 0.006) and longer time to first flatus (p = 0.001), compared to the normal BMI subgroup. Conversely, in the D2 + CME group, significant differences were not observed in early surgical outcomes between the two subgroups(p > 0.05). PSM yielded 44 high BMI patients with comparable baseline characteristics into the A group and the B group. Compared to the A group, patients with high BMI in the B group who received laparoscopic D2 + CME had shorter surgery time(p<0.001), less blood loss(p = 0.004), more retrieved lymph nodes (LNs) (p = 0.016). No statistical differences were observed in terms of the first flatus time, pT stage, pN stage, pathological stage(pStage), vascular invasion, postoperative complications, or postoperative hospital stay(p > 0.05). CONCLUSION Our findings suggest the high BMI status had a significant impact on the early surgical results of laparoscopic conventional D2 lymphadenectomy. However, laparoscopic D2 + CME was unaffected by a high BMI. In addition, patients with high BMI benefit more from laparoscopic D2 + CME in terms of short-term outcomes. Laparoscopic D2 + CME is a recommended technique for distal gastric cancer patients with high BMI, which deserves further study and promotion.
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Affiliation(s)
- Yong Sun
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Chengde, Hebei, 067000, China
| | - Lei Hou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Chengde, Hebei, 067000, China
| | - Enhong Zhao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Chengde, Hebei, 067000, China.
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Muduly DK, Colney L, Kar M, Imaduddin M, Patra S, Sultania M, G S, Swain PK, Sahoo B, Mohakud S, Nayak HK, Panigrahi MK. Effect of Preoperative Body Mass Index on Postoperative and Long-Term Outcomes in an East Indian Gastric Cancer Cohort. J Gastrointest Cancer 2024; 55:829-837. [PMID: 38315330 DOI: 10.1007/s12029-024-01018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Gastric cancer is a global health concern with varying clinical outcomes. This study aims to investigate the influence of preoperative Body Mass Index (BMI) on survival in patients who underwent curative resection for gastric cancer in Eastern India. METHODS Data from a prospectively maintained Surgical Oncology database were analysed for patients who underwent curative resection for primary gastric adenocarcinoma between May 2016 and March 2022. Patients with incomplete data were excluded. Preoperative BMI was categorised into three groups: Underweight (< 18.5 kg/m2), Normal (18.5-22.9 kg/m2), and Overweight/Obese (=23 kg/m2). Clinicopathological details, short-term outcomes, and long-term oncological outcomes were assessed. Statistical analysis included survival estimates, Cox proportional hazard models, and subgroup analysis. RESULT Of 162 patients, 145 met the inclusion criteria. Patients were predominantly male (68%) with middle or lower socioeconomic status. No significant differences amongst BMI groups were observed in performance score, tumour grade, clinical stage, or short-term outcomes. Postoperative complications and 30-day mortality were similar. However, underweight patients had poorer 4-year disease-free survival (DFS) compared to overweight/obese patients (14.3% vs. 39.7%, p = 0.03). Overweight/obese patients showed significantly better 4-year overall survival (OS) than underweight patients (47.8% vs. 20.4%, p = 0.03). CONCLUSIONS In Eastern Indian gastric cancer patients undergoing curative resection, preoperative higher BMI (overweight/obese) was associated with better long-term survival. Understanding these findings could guide tailored interventions to improve outcomes in this population.
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Affiliation(s)
- Dillip Kumar Muduly
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India.
| | - Lalchhandami Colney
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Madhabananda Kar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mohammed Imaduddin
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudhakar G
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Phanindra Kumar Swain
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Hemanta Kumar Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Wen ZL, Xiao DC, Zhou X. Does Intraoperative Blood Loss Affect the Short-Term Outcomes and Prognosis of Gastric Cancer Patients After Gastrectomy? A Meta-Analysis. Front Surg 2022; 9:924444. [PMID: 35774383 PMCID: PMC9237360 DOI: 10.3389/fsurg.2022.924444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of the current meta-analysis was to analyze whether intraoperative blood loss (IBL) influenced the complications and prognosis of gastric cancer patients after gastrectomy. Methods We systematically searched the PubMed, Embase and Cochrane library databases on November 29, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. This meta-analysis uses RevMan 5.3 for data analysis. Results A total of nine retrospective studies were included in this meta-analysis, involving 4653 patients. In terms of short-term outcomes, the Larger IBL group has a higher complication rate (OR = 1.94, 95% CI, 1.44 to 2.61, P < 0.0001) and a longer operation time (OR = 77.60, 95% CI, 41.95 to 113.25, P < 0.0001) compared with the smaller IBL group, but the Larger IBL group had higher total retrieved lymph nodes (OR = 3.68, 95% CI, 1.13 to 6.24, P = 0.005). After pooling up all the HRs, the Larger IBL group has worse overall survival (OS) (HR = 1.80, 95% CI, 1.27 to 2.56, P = 0.001) and disease-free survival (DFS) (HR = 1.48, 95% CI, 1.28 to 1.72, P < 0.00001). Conclusion Larger IBL increased operation time and postoperative complications, and decreased OS and DFS of gastric cancer patients. Therefore, surgeons should be cautious about IBL during operation.
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Chen K, Pan Y, Zhai ST, Cai JQ, Chen QL, Chen DW, Zhu YP, Zhang Y, Zhang YP, Maher H, Wang XF. Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods. BMC Gastroenterol 2017. [PMID: 28629379 PMCID: PMC5477413 DOI: 10.1186/s12876-017-0638-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Obesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer. Methods We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients. Results A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients. Conclusions Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.
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Affiliation(s)
- Ke Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Shu-Ting Zhai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Jia-Qin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Qi-Long Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Ding-Wei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yi-Ping Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Yu Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Ya-Ping Zhang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China
| | - Hendi Maher
- School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang Province, 310058, China
| | - Xian-Fa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
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Short-term outcomes for laparoscopy-assisted distal gastrectomy for body mass index ≥30 patients with gastric cancer. J Surg Res 2014; 195:83-8. [PMID: 25617970 DOI: 10.1016/j.jss.2014.12.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/11/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obesity is known to be a preoperative risk factor for gastric cancer surgery. This study aimed to investigate the influence of obesity on the surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. METHODS The clinical data of 131 patients with gastric cancer from January 2010-December 2013 were analyzed retrospectively. Perioperative outcomes were compared between 43 patients with a body mass index (BMI) ≥30 kg/m(2) (obese group) and 88 patients with a BMI <30 kg/m(2) (nonobese group) who underwent LADG. RESULTS Operation times were significantly longer for the obese group than for the nonobese group (234.1 ± 57.2 min versus 212.2 ± 43.5 min, P = 0.026). There were no statistically significant differences between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P > 0.05). During the follow-up period of 5 mo-49 mo (average, 36 mo), the overall survival rates were not significantly different between the two groups (80.0% [32/40] versus 81.9% [68/83], P > 0.05). The differences in recurrence and metastasis between the two groups were not statistically significant. CONCLUSIONS Our analysis revealed that LADG can be safely performed in patients with BMI ≥30. The procedure was considered to be difficult but sufficiently feasible.
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Li L, Li X, Chu S, Tian J, Su J, Tian H, Sun R, Yang K. Does overweight affect outcomes in patients undergoing gastrectomy for cancer? A meta-analysis of 25 cohort studies. Jpn J Clin Oncol 2014; 44:408-415. [PMID: 24719478 DOI: 10.1093/jjco/hyu031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Overweight was regarded as one of the risk factors for poor outcome after gastrectomy, but its influence on the surgical and postoperative outcomes of gastrectomy was unclear. METHODS Comprehensive searches were conducted to include cohort studies which evaluated the influence of overweight on the surgical and postoperative outcomes of gastrectomy. Data was analyzed by RevMan 5.0. RESULTS Twenty-five cohort studies (18 518 patients) were included. Overweight patients were associated with longer operation time (mean difference 20.88, 95% confidence interval 14.07, 27.69), more intraoperative blood loss (mean difference 35.45, 95% confidence interval 9.24, 61.67), and less retrieved lymph nodes (mean difference -2.17, 95% confidence interval -3.51, -0.83) than normal patients undergoing laparoscopy-assisted gastrectomy. And overweight patients were associated with longer operation time (mean difference 26.31, 95% confidence interval 21.92, 30.70), more intraoperative blood loss (mean difference 130.02, 95% confidence interval 75.49, 184.55), less retrieved lymph nodes (mean difference -3.18, 95% confidence interval -4.74, -1.61), longer postoperative hospital stay (mean difference 2.37, 95% confidence interval 0.03, 4.70) and more postoperative complications (risk ratio 1.53, 95% confidence interval 1.29, 1.80) than normal patients in open gastrectomy. CONCLUSIONS Overweight might affect the clinical results of both laparoscopy-assisted and open gastrectomy, especially for open gastrectomy.
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Affiliation(s)
- Lun Li
- *Dong Gang West Road No. 199, Lanzhou, Gansu, China.
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Kong F, Li H, Fan Y, Zhang X, Cao S, Yu J, Ren X, Hao X. Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis. Obes Surg 2013; 23:650-6. [PMID: 23371777 DOI: 10.1007/s11695-012-0847-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and long-term outcome in gastric cancer patients following radical gastrectomy continues to be debated. We investigated the association between BMI, clinicopathological features, and prognosis in Chinese gastric carcinoma patients. METHODS A retrospective consecutive cohort study was performed on 1,296 patients who underwent gastrectomy with curative intent at the Tianjin Cancer Institute Hospital between 1999 and 2004. The clinicopathological characteristics, overall 5-year survival rate (OS), and preoperative and six-month postoperative BMIs of both overweight (BMI ≥ 25 kg/m(2); H-BMI; n = 364) and non-overweight (BMI <25 kg/m(2); N-BMI; n = 932) patients were compared. RESULTS Among these patients, 364 (28.1 %) were overweight. The OS was significantly higher in the H-BMI than N-BMI group (33.2 vs. 24.1 %, respectively; p < 0.001). Preoperative and six-month postoperative BMIs were 27.1 ± 2.0 and 24.8 ± 2.0 kg/m(2), respectively, in the H-BMI group (p < 0.001), whereas they were 21.7 ± 2.2 and 20.7 ± 2.2 kg/m(2), respectively, in the N-BMI group (p = 0.007). There was significantly better differentiation (p = 0.034), less distant metastases (p = 0.006), and a lower metastatic lymph node ratio (p = 0.014) observed in the H-BMI groups. Multivariate analyses indicated age, BMI, pathological tumor depth, distant metastases, metastatic lymph node ratio, and tumor size as independent prognostic factors. CONCLUSIONS Our findings suggest that overweight patients were less likely to have tumors with aggressive features and can achieve ideal body weight following curative gastrectomy, possibly resulting in better long-term prognosis.
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Affiliation(s)
- Fanming Kong
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, China
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Wu XS, Wu WG, Li ML, Yang JH, Ding QC, Zhang L, Mu JS, Gu J, Dong P, Lu JH, Liu YB. Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19:4596-4606. [PMID: 23901238 PMCID: PMC3725387 DOI: 10.3748/wjg.v19.i27.4596] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/31/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer.
METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m2] or overweight (BMI ≥ 25 kg/m2). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software.
RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m2; 4897 with BMI ≥ 25 kg/m2). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay.
CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
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Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19:4596-4606. [DOI: 10.3748/wjg.v19.i28.4596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer.
METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m2] or overweight (BMI ≥ 25 kg/m2). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software.
RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m2; 4897 with BMI ≥ 25 kg/m2). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay.
CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
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Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today 2011; 41:928-34. [DOI: 10.1007/s00595-010-4397-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 04/04/2010] [Indexed: 12/29/2022]
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Gastric cancer. Crit Rev Oncol Hematol 2009; 71:127-64. [PMID: 19230702 DOI: 10.1016/j.critrevonc.2009.01.004] [Citation(s) in RCA: 323] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 01/08/2009] [Accepted: 01/15/2009] [Indexed: 02/08/2023] Open
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Shim JH, Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 2009; 39:481-6. [PMID: 19468803 DOI: 10.1007/s00595-008-3829-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 06/09/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE It is generally considered difficult to operate on overweight patients, who are also at increased risk of postoperative complications. We conducted this study to clarify the technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) in overweight patients. METHODS Between July 2004 and December 2006, 116 patients with preoperatively diagnosed EGC underwent LADG at our department. We classified these patients into two groups based on body mass index (BMI). There were 60 patients in the high-BMI (> or =23 kg/m2) group and 56 in the low-BMI (<23 kg/m2) group. The clinicopathologic features, postoperative outcomes, and operation-related morbidities were compared. RESULTS None of the patients needed conversion to laparotomy. There were no notable differences in clinical characteristics or histologic features between the groups. Although the operation time was significantly longer in the high-BMI group, there were no significant differences in postoperative bowel recovery, postoperative hospital stay, or operation-related morbidities. CONCLUSIONS Laparoscopy-assisted distal gastrectomy for overweight patients is feasible and safe; however, because of its technical difficulties and the complexities of lymph node dissection, it should be carefully considered, and may only be suitable for early-stage cancers.
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Affiliation(s)
- Jung Ho Shim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Republic of Korea
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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; 24:475-9. [PMID: 19054266 DOI: 10.1111/j.1440-1746.2008.05704.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The prevalence of being overweight has risen remarkably in Korea. This study sought to clarify the relationship between being overweight and surgical outcomes in gastric cancer patients. METHODS A total of 410 patients who underwent curative total gastrectomies with D2 dissection from January 2000 to December 2003 were retrospectively studied from a prospectively designed database. The patients were assigned to two groups based upon their body mass index (BMI): non-overweight, BMI < 25 kg/m(2); overweight, BMI >or= 25 kg/m(2). Perioperative surgical outcomes, postoperative morbidity, mortality, recurrence, and prognosis were analyzed. RESULTS The overweight group had longer operation time and more postoperative complications than the non-overweight group. The two groups were similar in terms of transfusion volumes, postoperative bowel movement, time to initiation of a soft diet, and postoperative hospital stay. Patterns of recurrence and cumulative survival rates were similar for each group. Multivariate analysis showed that being overweight was not a risk factor for recurrence or poor prognosis. CONCLUSION Although being overweight was associated with increased operation time and higher risk of complications in gastric cancer patients undergoing curative total gastrectomy, it had no effect on recurrence or long-term survival.
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Affiliation(s)
- Sung Jin Oh
- Department of Surgery, Yonsei University College of Medcine, Seoul, Korea
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14
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Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, Park SR, Kim YW, Kook MC, Nam BH, Bae JM. Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 2007; 14:1288-94. [PMID: 17225982 DOI: 10.1245/s10434-006-9235-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a prevailing belief that both obesity and abdominal shape influence abdominal accessibility, and thus affect short-term surgical outcomes of gastric cancer surgery. METHODS We measured the thickness of subcutaneous fat (SCF), abdominal anterior-posterior diameter (APD), transverse diameter (TD), and intra-abdominal fat volume (IFV) at the umbilicus level by using the abdominal CT scans of 291 gastric cancer patients who had undergone subtotal gastrectomy and D2 lymph node dissection. Clinicopathological factors including body mass index (BMI), APD, TD, IFV, and SCF and surgical outcomes, i.e., dissected lymph node number, morbidity, and mortality were analyzed. RESULTS SCF thickness, APD, TD, IFV, and BMI mean values were 20.0 mm (range 2.0-64.0), 188.4 mm (range 128.0-332.0), 301.4 mm (range 160.0-651.0), 198.3 mm(2) (range 123.4-312.1), and 23.9 kg/m(2) (range 16.6-34.6), respectively. In male patients, APD was found to correlate with the number of retrieved lymph nodes (P = 0.045). Whereas in female patients, this was not the case (P = 0.093). Twenty-one patients experienced postoperative complications but no postoperative mortality occurred. Female patients who experienced postoperative complications had higher APD (32.9 +/- 10.0 mm versus 26.1 +/- 7.9 mm, P = 0.044) and BMI (27.3 +/- 4.1 kg/m(2) versus 24.3 +/- 3.5 kg/m(2), P = 0.049) values than those who did not. CONCLUSIONS We conclude that obesity and abdominal shape of gastric cancer patients both influence the short-term surgical outcomes of subtotal gastrectomy with D2 lymph node dissection.
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Affiliation(s)
- Jun Ho Lee
- Research Institute and Hospital, National Cancer Center, 809 Madu1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 411-769, Korea
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15
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Surgery Today The Japanese Journal of Surgery. Br J Surg 2005. [DOI: 10.1002/bjs.1800830411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This month's selection from the October to December 1995 issues of Surgery Today (The Japanese Journal of Surgery) is written by Professor K. Sugimachi. A digest of the BJS for the same period, written by Mr Colin Johnson, appears in the Japanese journal.
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16
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Fujiwara M, Kodera Y, Kasai Y, Kanyama Y, Hibi K, Ito K, Akiyama S, Nakao A. Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases. J Am Coll Surg 2003; 196:75-81. [PMID: 12517554 DOI: 10.1016/s1072-7515(02)01539-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recently, laparoscopy and laparoscopy-assisted surgery have been used increasingly as less-invasive alternatives to conventional open surgery. But the use of this approach in gastric carcinoma has received little attention, possibly from the low incidence of early-stage disease in the West and the relative complexity of the surgical procedure. STUDY DESIGN A prospective feasibility study of laparoscopy-assisted distal gastrectomy was performed in patients with histologically confirmed gastric carcinoma located in the lower or middle third of the stomach. Patients whose preoperative evaluations, including endoscopic ultrasonography and computerized tomography, led to a diagnosis of T1 N0 stage disease, and who had no advanced disease discovered during laparoscopy, were eligible. Intraoperative blood loss, time of operation, mortality, and morbidity were assessed, along with the number of lymph nodes retrieved and shortterm survival. RESULTS Between 1998 and 1999, 43 patients were enrolled. Laparoscopy-assisted distal gastrectomy was converted to an open procedure in one patient. There were no operative or in-hospital deaths, but the incidence of anastomotic leakage was 14% (6 of 43). The mean blood loss was 239 mL, the time of operation was 225 minutes, and lymph node retrieval was 20.2 nodes. These results are comparable with a series of conventional open operations. One patient died of recurrent disease, and all other patients remain disease-free to date. Port-site recurrence was not observed. CONCLUSIONS Although laparoscopy-assisted distal gastrectomy was equivalent to open surgery in several clinical parameters, the relatively high morbidity was a drawback. Its appropriateness to gastric cancer surgery must be verified by further studies.
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Affiliation(s)
- Michitaka Fujiwara
- Department of Surgery II, Nagoya University School of Medicine, Nagoya/Aichi, Japan
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17
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Davis PA, Sano T. The difference in gastric cancer between Japan, USA and Europe: what are the facts? what are the suggestions? Crit Rev Oncol Hematol 2001; 40:77-94. [PMID: 11578917 DOI: 10.1016/s1040-8428(00)00131-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In Japan the survival rate for gastric cancer has steadily improved over the last 30 years whilst that in the West has remained static and inferior. In this review three hypotheses are examined to explain the difference. There is little evidence to suggest genetic differences, which might result in a less aggressive cancer in Japan. Recently there has been a rise in the proportion of cancers of the gastro-oesophageal junction in the West and this has not been seen in Japan. The comparison of survival data from these two regions is problematic with different staging systems and a stage migration effect. The established surgical treatment of gastric cancer in Japan is radical gastrectomy and regional lymphadenectomy and this has been proposed as a superior treatment to the standard gastrectomy common in the West. The results for survival benefit however, have not been reproduced in randomized clinical trials. The heterogeneity of adjuvant and neoadjuvant treatment regimens in Japan and the West has led to difficulties in the interpretation of their effects. There is considerable scope for future collaboration between clinicians in the West and Japan.
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Affiliation(s)
- P A Davis
- Imperial College School of Medicine, St. Mary's Hospital, London, UK
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