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Cullinane C, Fullard A, Croghan SM, Elliott JA, Fleming CA. Effect of obesity on perioperative outcomes following gastrointestinal surgery: meta-analysis. BJS Open 2023; 7:zrad026. [PMID: 37428558 PMCID: PMC10332403 DOI: 10.1093/bjsopen/zrad026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Obesity can pose perioperative challenges related to obesity-associated co-morbidities and technical factors. However, the true impact of obesity on postoperative outcomes is not well established and reports are conflicting. The aim was to perform a systematic review and meta-analysis to explore the effect of obesity on perioperative outcomes for general surgery procedures in distinct obesity subtypes. METHODS A systematic review was performed for studies reporting postoperative outcomes in relation to BMI in upper gastrointestinal, hepatobiliary and colorectal based on an electronic search using the Cochrane Library, Science Direct, PubMed and Embase up to January 2022. The primary outcome was the incidence of 30-day postoperative mortality among patients with obesity undergoing general surgical procedures in comparison to patients with normal range BMI. RESULTS Sixty-two studies, including 1 886 326 patients, were eligible for inclusion. Overall, patients with obesity (including class I/II/II) had lower 30-day mortality rates in comparison to patients with a normal BMI (odds ratio (OR) 0.75, 95 per cent c.i. 0.66 to 0.86, P < 0.0001, I2 = 71 per cent); this was also observed specifically in emergency general surgery (OR 0.83, 95 per cent c.i. 0.79 to 0.87, P < 0.0000001, I2 = 7 per cent). Compared with normal BMI, obesity was positively associated with an increased risk of 30-day postoperative morbidity (OR 1.11, 95 per cent c.i. 1.04 to 1.19, P = 0.002, I2 = 85 per cent). However, there was no significant difference in postoperative morbidity rates between the cohorts of patients with a normal BMI and class I/II obesity (OR 0.98, 95 per cent c.i. 0.92 to 1.04, P = 0.542, I2 = 92 per cent). Overall, the cohort with obesity had a higher rate of postoperative wound infections compared with the non-obese group (OR 1.40, 95 per cent c.i. 1.24 to 1.59, P < 0.0001, I2 = 82 per cent). CONCLUSION These data suggest a possible 'obesity paradox' and challenge the assumption that patients with obesity have higher postoperative mortality compared with patients with normal range BMI. Increased BMI alone is not associated with increased perioperative mortality in general surgery, highlighting the importance of more accurate body composition assessment, such as computed tomography anthropometrics, to support perioperative risk stratification and decision-making. REGISTRATION NUMBER CRD42022337442 (PROSPERO https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Carolyn Cullinane
- Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland
| | - Anna Fullard
- Department of General and Colorectal Surgery, University of Limerick Hospital Group, Limerick, Ireland
| | - Stefanie M Croghan
- Department of Urology, Royal College of Surgeons Ireland, St Stephen’s Green, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity College Dublin, and St. James’s Hospital, Dublin, Ireland
| | - Christina A Fleming
- Department of General and Colorectal Surgery, University of Limerick Hospital Group, Limerick, Ireland
- Progress Women in Surgery Fellowship, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hirano Y, Kaneko H, Konishi T, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Itano O, Yasunaga H, Kitagawa Y. Impact of Body Mass Index on Major Complications, Multiple Complications, In-hospital Mortality, and Failure to Rescue After Esophagectomy for Esophageal Cancer: A Nationwide Inpatient Database Study in Japan. Ann Surg 2023; 277:e785-e792. [PMID: 35129484 DOI: 10.1097/sla.0000000000005321] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association of BMI with mortality and related outcomes after oncologic esophagectomy. SUMMARY BACKGROUND DATA Previous studies showed that high BMI was a risk factor for anastomotic leakage and low BMI was a risk factor for respiratory complications after esophagectomy. However, the association between BMI and in-hospital mortality after oncologic esophagectomy remains unclear. METHODS Data for patients who underwent esophagectomy for esophageal cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Multivariate regression analyses and restricted cubic spline analyses were used to investigate the associations between BMI and short-term outcomes, adjusting for potential confounders. RESULTS Among 39,406 eligible patients, in-hospital mortality, major complications, and multiple complications (≥2 major complications) occurred in 1069 (2.7%), 14,824 (37.6%), and 3621 (9.2%), respectively. Compared with normal weight (18.5-22.9 kg/m 2 ), severe underweight (<16.0 kg/m 2 ), mild/moderate underweight (16.0-18.4 kg/m 2 ), and obese (≥27.5 kg/m 2 )were significantly associated with higher in-hospital mortality [odds ratio 2.20 (95% confidence interval 1.65-2.94), 1.25 (1.01-1.49), and 1.48 (1.05-2.09), respectively]. BMI showed U-shaped dose-response associations with mortality, major complications, and multiple complications. BMI also showed a reverse J-shaped association with failure to rescue (death after major complications). CONCLUSIONS Both high BMI and low BMI were associated with mortality, major complications and multiple complications after esophagectomy for esophageal cancer. Patients with low BMI were more likely to die once a major complication occurred. The present results can assist with risk stratification in patients undergoing oncologic esophagectomy.
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Affiliation(s)
- Yuki Hirano
- Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Hidehiro Kaneko
- Department of cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Osamu Itano
- Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Lee JY, Choi Y. Low body mass index is associated with poor treatment outcome following radiotherapy in esophageal squamous cell carcinoma. Radiat Oncol J 2023; 41:40-47. [PMID: 37013417 PMCID: PMC10073840 DOI: 10.3857/roj.2022.00640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose: We aimed to determine whether patients with esophageal cancer with a low baseline body mass index (BMI) have a poor prognosis following radiotherapy (RT).Materials and Methods: We retrospectively analyzed data from 50 patients with esophageal cancer to determine whether a low starting BMI (before RT) was associated with a poor outcome. All study participants were diagnosed with non-metastatic esophageal squamous cell carcinoma (SCC).Results: The number of patients at each T stage were as follows: 7 (14%) patients at T1, 18 (36%) at T2, 19 (38%) at T3, and 6 (12%) at T4. Based on BMI, 7 (14%) patients were defined as underweight. A low BMI was common in patients with T3/T4 stage esophageal cancer (7/43, p = 0.01). Overall, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 26.3% and 69.2%, respectively. In univariate analysis, clinical factors associated with poor PFS included being underweight (BMI <18.5 kg/m2; p = 0.011) and a positive N status (p = 0.017). Univariate analysis also revealed that being underweight was associated with a decrease in OS (p = 0.003). However, being underweight was not an independent prognostic factor for PFS and OS. Conclusion: Patients with esophageal SCC with a low starting BMI (BMI <18.5 kg/m2) are more prone to have a negative survival outcome following RT than patients who are considered to be normal weight or overweight. For this reason, it is important that clinicians pay more attention to BMI when treating patients with esophageal SCC.
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Affiliation(s)
- Ji-young Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yunseon Choi
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- Correspondence: Yunseon Choi Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-8606 E-mail :
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4
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The effect of preoperative body mass index on short-term outcome after esophagectomy for cancer: A nationwide propensity score–matched analysis. Surgery 2022; 172:137-144. [DOI: 10.1016/j.surg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 01/14/2023]
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Feng JF, Wang L, Yang X. The preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score is a useful predictor in patients with resectable esophageal squamous cell carcinoma. Bosn J Basic Med Sci 2021; 21:773-781. [PMID: 33974528 PMCID: PMC8554699 DOI: 10.17305/bjbms.2021.5666] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022] Open
Abstract
The hemoglobin, albumin, lymphocyte and platelet (HALP) score has been confirmed as a prognostic factor in several types of cancers. The current study aimed to assess the prognostic value of preoperative HALP score, an inflammatory and nutritional based score, in predicting cancer-specific survival (CSS) in resectable patients undergoing curative resection for esophageal squamous cell carcinoma (ESCC). The clinical data of 355 consecutive patients with ESCC who underwent curative resection were retrospectively conducted and analyzed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value for preoperative HALP. The areas under the curve (AUC) for preoperative HALP and other variables were calculated and compared. Cox regression analyses and Kaplan-Meier methods were used to identify the factors associated with CSS. According to the ROC curve, the optimal cut-off value for preoperative HALP was 31.8. The 5-year CSS for preoperative HALP low (≤31.8) and high (>31.8) was 15.1% and 47.5%, respectively (p < 0.001). Preoperative HALP had reliable abilities to predict CSS in resectable ESCC patients in any stage or gender, according to the subgroup analysis based on the patients' cancer stage and gender. Multivariate analyses confirmed that preoperative HALP was an independent prognostic score regarding CSS in patients with resectable ESCC (p < 0.001). This study confirmed that the postoperative HALP score could be regarded as a potential independent prognostic factor for CSS in patients with resectable ESCC.
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Affiliation(s)
- Ji-Feng Feng
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Liang Wang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xun Yang
- Department of Thoracic Oncological Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
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Chronological Changes in Skeletal Muscle Mass Two Years after Minimally Invasive Esophagectomy: A Prospective Cohort Study. Surg Endosc 2021; 36:1527-1535. [PMID: 33755788 DOI: 10.1007/s00464-021-08440-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Preoperative loss of skeletal muscle mass, defined as sarcopenia, has been reported to be associated with higher incidence of complications following esophagectomy in patients with esophageal cancer. Although skeletal muscle loss promotes disability and reduced quality of life (QOL), only a few studies have focused on changes in skeletal muscle mass after surgery. This prospective cohort study aimed to evaluate the chronological changes in skeletal muscle mass after minimally invasive esophagectomy (MIE). METHODS Patients with esophageal cancer scheduled to undergo MIE at our institution were prospectively registered. Skeletal muscle mass was evaluated before and 2, 6, 12, and 24 months after surgery. The effects of preoperative sarcopenia on surgical outcomes and chronological changes in skeletal muscle mass were evaluated. RESULTS Among the 71 eligible preoperative patients, 29 (40.8%) were diagnosed with sarcopenia. Patients with sarcopenia had significantly higher incidences of total (79.3% vs 52.4%, p = 0.026) and gastrointestinal (37.9% vs 11.9%, p = 0.019) complications and a significantly longer length of hospital stay (31 vs 23 days, p = 0.005) than those without sarcopenia. The median skeletal muscle mass index (kg/m2) was 7.09 before surgery, which decreased to 6.46 two months after surgery (- 7.2%, P < 0.01). Thereafter, values of 6.90, 6.86, and 7.06 were reported at 6, 12, and 24 months after surgery, respectively. CONCLUSION Patients with preoperative sarcopenia developed more postoperative complications than those without it. Additionally, patients experienced a decrease in skeletal muscle mass during the early postoperative period following MIE. Further research on perioperative countermeasures to prevent skeletal muscle loss during the early postoperative period and to prevent postoperative complications is necessary for patients undergoing MIE.
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Danwang C, Agbor VN, Bigna JJ. Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis. BMC Surg 2020; 20:194. [PMID: 32867744 PMCID: PMC7457363 DOI: 10.1186/s12893-020-00848-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. Methods We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. Results Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55–4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54–2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58–5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05–3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02–14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13–3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16–2.34; I2 = 19.5%). Conclusions This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.
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Affiliation(s)
- Celestin Danwang
- Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium. .,Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Clinical Research, Health Education and Research Organisation (HERO), Buea, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Paris, France
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8
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Hagens ER, Feenstra ML, van Egmond MA, van Laarhoven HW, Hulshof MC, Boshier PR, Low DE, van Berge Henegouwen MI, Gisbertz SS. Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment. J Cachexia Sarcopenia Muscle 2020; 11:756-767. [PMID: 32096923 PMCID: PMC7296271 DOI: 10.1002/jcsm.12540] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/30/2019] [Accepted: 01/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post-operative morbidity and long-term survival. METHODS This retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross-sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx. RESULTS A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post-operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87-0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30-2.53, P = 0.001) were associated with worse overall survival. CONCLUSIONS Sarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.
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Affiliation(s)
- Eliza R.C. Hagens
- Department of SurgeryAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Minke L. Feenstra
- Department of SurgeryAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Maarten A. van Egmond
- Department of RehabilitationAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical OncologyAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Maarten C.C.M. Hulshof
- Department of RadiotherapyAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Piers R. Boshier
- Department of Thoracic Surgery and Thoracic OncologyVirginia Mason Medical CenterSeattleWAUSA
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Donald E. Low
- Department of Thoracic Surgery and Thoracic OncologyVirginia Mason Medical CenterSeattleWAUSA
| | - Mark I. van Berge Henegouwen
- Department of SurgeryAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Suzanne S. Gisbertz
- Department of SurgeryAmsterdam University Medical Centers, University of Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
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Loehrer EA, Giovannucci EL, Betensky RA, Shafer A, Christiani DC. Prediagnostic adult body mass index change and esophageal adenocarcinoma survival. Cancer Med 2020; 9:3613-3622. [PMID: 32202699 PMCID: PMC7221446 DOI: 10.1002/cam4.3015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/10/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background We examined whether body mass index (BMI) changes in adulthood, prior to disease onset, are associated with overall survival among esophageal adenocarcinoma patients. Methods We included 285 histologically confirmed patients with a complete baseline BMI questionnaire. Using extended Cox regression models, we obtained adjusted hazard ratios (HRs) for the associations between overall survival and BMI at diagnosis, BMI 6 months before diagnosis, self‐reported average adult BMI, and ΔBMI (BMI 6 months before diagnosis minus average adult BMI), categorized into tertiles <0 kg/m2 (BMI loss), ≥0 and <1.25 kg/m2 (stable BMI), and ≥1.25 kg/m2 (BMI gain). We also assessed interaction between ΔBMI and average adult BMI (≥ kg/m2 versus <27.5 kg/m2) with overall survival. Results Body mass index at diagnosis >25 and <35 kg/m2 was associated with better overall survival. Compared to patients with stable BMI in adulthood, patients who gained BMI throughout adulthood had 1.68 times the all‐cause hazard of death (95% CI: 1.17‐2.43; P < .01), independent of diagnosis BMI and percent weight loss 6 months before diagnosis. Compared to patients with average adult BMI < 27.5 who maintained stable adult BMI, patients with average adult BMI ≥ 27.5 kg/m2 who gained BMI had the worst survival (HR = 3.05; 95% CI 1.62‐5.72; P < .01). Conclusion Body mass index gain in adulthood is associated with poor overall survival, and maintaining a normal body weight throughout adulthood is associated with the best overall survival among esophageal adenocarcinoma patients, independent of BMI at diagnosis.
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Affiliation(s)
- Elizabeth A Loehrer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea Shafer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Massachusetts General Hospital, Boston, MA, USA
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10
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Kamarajah SK, Lin A, Tharmaraja T, Bharwada Y, Bundred JR, Nepogodiev D, Evans RPT, Singh P, Griffiths EA. Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus 2020; 33:5709700. [PMID: 31957798 DOI: 10.1093/dote/doz089] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022]
Abstract
Anastomotic leaks (AL) are a major complication after esophagectomy. This meta-analysis aimed to determine identify risks factors for AL (preoperative, intra-operative, and post-operative factors) and assess the consequences to outcome on patients who developed an AL. This systematic review was performed according to PRISMA guidelines, and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling and prospectively registered with the PROSPERO database (Registration CRD42018130732). This review identified 174 studies reporting outcomes of 74,226 patients undergoing esophagectomy. The overall pooled AL rates were 11%, ranging from 0 to 49% in individual studies. Majority of studies were from Asia (n = 79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99-6.89, P < 0.001) and cardiac complications (OR: 2.44, CI95%: 1.77-3.37, P < 0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10-21 days, P < 0.001), and in-hospital mortality (OR: 5.91, CI95%: 1.41-24.79, P = 0.015). AL are a major complication following esophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL, which can be a target for interventions to reduce AL rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counseling, and informed consent.
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Affiliation(s)
- Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK.,Institute of Cellular Medicine, University of Newcastle, Newcastle Upon Tyne, UK
| | - Aaron Lin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thahesh Tharmaraja
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yashvi Bharwada
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James R Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dmitri Nepogodiev
- Department of Academic Surgery and College of Medical and Dental Sciences, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Richard P T Evans
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pritam Singh
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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11
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Thomas M, Defraene G, Lambrecht M, Deng W, Moons J, Nafteux P, Lin SH, Haustermans K. NTCP model for postoperative complications and one-year mortality after trimodality treatment in oesophageal cancer. Radiother Oncol 2019; 141:33-40. [DOI: 10.1016/j.radonc.2019.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022]
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12
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Hall BR, Flores LE, Parshall ZS, Shostrom VK, Are C, Reames BN. Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure-targeted analysis. J Surg Oncol 2019; 120:661-669. [PMID: 31292967 DOI: 10.1002/jso.25613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. METHODS Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. RESULTS Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak. CONCLUSION Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.
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Affiliation(s)
- Bradley R Hall
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Zachary S Parshall
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, Nebraska
| | - Chandrakanth Are
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bradley N Reames
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
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13
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Corsini EM, Sepesi B. Editorial on "Complications after esophagectomy are associated with extremes of body mass index". J Thorac Dis 2019; 11:354-356. [PMID: 30962972 DOI: 10.21037/jtd.2018.11.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Wang P, Li Y, Sun H, Liu S, Zhang R, Liu X, Zhu Z. Predictive Value of Body Mass Index for Short-Term Outcomes of Patients with Esophageal Cancer After Esophagectomy: A Meta-analysis. Ann Surg Oncol 2019; 26:2090-2103. [DOI: 10.1245/s10434-019-07331-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 02/06/2023]
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15
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Li B, Ren Q, Ling J, Tao Z, Yang X, Li Y. The change of Th17/Treg cells and IL-10/IL-17 in Chinese children with Henoch-Schonlein purpura: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e13991. [PMID: 30653104 PMCID: PMC6370168 DOI: 10.1097/md.0000000000013991] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To date, the relationship of Th17 and Treg cells to Henoch-Schonlein purpura (HSP) in children remains controversial. Therefore, a systematic review and meta-analysis was conducted to reveal the potential role of the Th17 and Treg cells in children in acute stage of HSP. METHODS PubMed, Embase, Web of Science and China National Knowledge Internet (CNKI) were systematically searched for eligible studies up to November 03, 2017. Quality assessment was carried out according to the modification of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Stata SE12.0 (StataCorp, College Station, TX). Standard mean difference (SMD) with 95% confidence intervals (CI) was calculated continuous data. RESULTS A total of 25 eligible studies were identified after a thorough literature search. The pooled results of the meta-analysis showed that values of Th17 frequency (SMD = 2.60; 95% CI: 1.98 to 3.23; P < .0001; I = 90.3%, P < .0001) and IL-17 level (SMD = 3.53; 95% CI: 2.71 to 4.35; P < .0001; I = 95.6%, P < .001) were significantly higher in children with HSP as compared to healthy children. In contrast, our analysis showed significant lower values of Treg frequency (SMD = -2.86; 95% CI: -3.53 to -2.19; P < .001; I = 92.4%, P < .001). However, no significance of IL-10 level was observed between children with HSP and healthy children (SMD = -1.22; 95% CI: -2.78 to 0.33; P < .01; I = 95.9%, P < .001). CONCLUSION In conclusion, our meta-analysis indicated that increased frequency of Th17 cells and level of IL-17, but lower frequency of Treg cells are associated with HSP in childhood. Considering the limitations of this meta-analysis, large-scaled studies need to be conducted to validate the current results.
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Affiliation(s)
| | - Qian Ren
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
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16
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Complications After Esophagectomy Are Associated With Extremes of Body Mass Index. Ann Thorac Surg 2018; 106:973-980. [DOI: 10.1016/j.athoracsur.2018.05.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/03/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
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17
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Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep 2018; 8:12561. [PMID: 30135506 PMCID: PMC6105611 DOI: 10.1038/s41598-018-30906-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023] Open
Abstract
Geriatric nutritional risk index (GNRI) is a novel and useful screening tool for evaluating nutritional status in elderly in-patients. We aimed to investigate whether the preoperative GNRI could be a predictive factor for outcomes in patients over 65 years of age with a diagnosis of hepatocellular carcinoma (HCC). We retrospectively enrolled 261 consecutive HCC patients after hepatectomy and classified them into four risk groups based on the GNRI values: high risk (GNRI, <82), moderate risk (GNRI, 82–92), low risk (GNRI, 92–98), and normal (GNRI, >98). We found that the lower GNRI value was significantly associated with severe postoperative complications (P < 0.001) and liver failure (P < 0.001). By multivariate logistic regression analysis, high risk- and moderate risk GNRI groups were identified as independent risk factors for postoperative serve complications and liver failure. Multivariate Cox regression analysis revealed preoperative GNRI (P < 0.001) adversely affected overall survival. In conclusion, preoperative GNRI could predict severe postoperative complications included liver failure, and the lower GNRI value was associated with worse overall survival after hepatectomy in elderly HCC patients.
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18
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Gao H, Feng HM, Li B, Lin JP, Yang JB, Zhu DJ, Jing T. Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11091. [PMID: 29995752 PMCID: PMC6076106 DOI: 10.1097/md.0000000000011091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of high body mass index (BMI, >23/25 kg/m) on surgical outcomes and prognosis in patients with esophageal carcinoma (EC) after undergoing esophagectomy remains controversial. We herein conducted a systematic review and meta-analysis to determine the relationship between high BMI and surgical outcomes and prognosis in patients undergoing esophagectomy for EC. METHODS The study search was conducted by retrieving publications from the PubMed, Embase, Web of Science, and CNKI (up to September 8, 2017). Nineteen studies with 13,756 patients were included in this meta-analysis. RESULTS We found that high BMI was closely associated with a higher incidence of wound infection (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.02-1.97, P = .04), cardiovascular complications (OR: 2.51, 95% CI, 1.65-3.81, P < .0001), and anastomotic leakage (OR: 1.50, 95% CI, 1.21-1.84, P = .0002), but a lower incidence of chylous leakage (OR: 0.59, 95% CI, 0.40-0.88, P = .01) when compared with normal BMI. The high BMI group was not associated with better or worse overall survival (OS) (hazard ratio [HR]: 0.95, 95% CI, 0.85-1.07, P = .4) and disease-free survival (HR: 0.95, 95% CI, 0.72-1.25, P = .72) than the normal BMI group. However, in the subgroup analysis, the pooled result of HRs generated from multivariate analyses suggested that high BMI could improve OS in EC patients (HR: 0.84, 95% CI, 0.76-0.93, P < .01). CONCLUSIONS Overweight patients with EC should not be denied surgical treatment, but intraoperative prevention and careful postoperative monitoring for several surgical complications must be stressed for this population. Besides, high BMI might be a prognostic predictor in EC patients; further studies are warranted.
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Affiliation(s)
| | - Hai-Ming Feng
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jun-Ping Lin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Jian-Bao Yang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Duo-Jie Zhu
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Tao Jing
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
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19
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Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum WH. The impact of obesity on esophagectomy: a meta-analysis. Dis Esophagus 2018; 31:4774514. [PMID: 29293968 DOI: 10.1093/dote/dox149] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/11/2022]
Abstract
The impact of body mass index (BMI) on postoperative outcomes after curative resection for esophageal cancer has been assessed in many studies worldwide with conflicting conclusions. The aim of this meta-analysis is to evaluate the influence of preoperative BMI on surgical and oncologic outcomes after radical surgery for esophageal cancer, in Western studies. A comprehensive electronic search was performed to identify Western publications reporting BMI and outcomes following surgery for esophageal cancer. Articles that did not report preoperative BMI, postoperative morbidity, and early mortality were excluded. Statistical analysis was performed using the OpenMetaAnalyst software (Version 10.10). One hundred and ninety records were examined and 8 studies were included with a total of 2838 patients. The study population was stratified into two groups: a nonobese group (BMI < 30 kg/m2), containing 2199 patients, and an obese group (BMI ≥ 30 kg/m2), with 639 patients. In the obese group, there was an increased risk (up to 35%) of anastomotic leak (P = 0.003; RR: 0.857, 95% CI: 0.497, 0.867). The obese group showed a significantly more favorable five-year overall survival (P = 0.011). Although there was a significant association between anastomotic leak and obesity, patients with obesity also have a better overall 5-year survival. This meta-analysis demonstrates that patients with obesity should be counseled regarding the specific risks of surgery but they can be reassured that despite these risks overall outcome is satisfactory.
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Affiliation(s)
- V Mengardo
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - F Pucetti
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - O Mc Cormack
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - A Chaudry
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - W H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
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20
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Abstract
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes.
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Affiliation(s)
- Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Falk Cardiovascular Research Building, 2nd Floor, Stanford, CA 94305, USA.
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21
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Yamana I, Takeno S, Shimaoka H, Yamashita K, Yamada T, Shiwaku H, Hashimoto T, Yamashita Y, Hasegawa S. Geriatric Nutritional Risk Index as a prognostic factor in patients with esophageal squamous cell carcinoma -retrospective cohort study. Int J Surg 2018; 56:44-48. [PMID: 29602015 DOI: 10.1016/j.ijsu.2018.03.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced to predict the risk of nutrition-related complications and mortality. Our aim is to examine the association between the GNRI and long-term prognosis in patients with esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy. METHODS The present study enrolled consecutive 216 patients with ESCC who underwent esophagectomy. The GNRI at admission to the hospital was calculated as follows: (1.489 × albumin, g/l) + (41.7 × present/ideal body weight). The characteristics and long-term prognosis were compared between four groups: the severe risk (GNRI: <82), moderate risk (GNRI: 82 to <92), low risk (GNRI: 92 to <98) and no risk (GNRI: >98) groups. The 5-year overall survival and independent prognostic factors were investigated, respectively. RESULTS A decreased GNRI significantly correlated with unfavorable overall survival (p < 0.001). In all patients, a multivariate analysis demonstrated that the severe and moderate risk groups (GNRI: <92) (hazard ratio 0.50; p = 0.002), T factor (≥T2) (hazard ratio 0.52; p = 0.026), and N positive factor (hazard ratio 0.47; p = 0.004) were independent prognostic factors. In the subgroup analysis, which excluded patients with preoperative chemoradiotherapy, the severe and moderate risk groups (GNRI: <92) (hazard ratio 0.48; p = 0.0057), and T factor (≥T2) (hazard ratio; p = 0.021) were independent prognostic factors. CONCLUSIONS GNRI is considered to be a useful prognostic factor in patients with ESCC undergoing esophagectomy.
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Affiliation(s)
- Ippei Yamana
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Shinsuke Takeno
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hideki Shimaoka
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kanefumi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Teppei Yamada
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hironari Shiwaku
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Tatsuya Hashimoto
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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22
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Järvinen T, Ilonen I, Kauppi J, Salo J, Räsänen J. Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer: a retrospective cohort study. World J Surg Oncol 2018; 16:27. [PMID: 29433514 PMCID: PMC5809976 DOI: 10.1186/s12957-018-1327-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/30/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Nutritional deficits, cachexia, and sarcopenia are extremely common in esophageal cancer. The aim of this article was to assess the effect of loss of skeletal muscle mass during neoadjuvant treatment on the prognosis of esophageal cancer patients. METHODS Esophageal cancer patients (N = 115) undergoing neoadjuvant therapy and surgery between 2010 and 2014 were identified from our surgery database and retrospectively analyzed. Computed tomography imaging of the total cross-sectional muscle tissue measured at the third lumbar level defined the skeletal muscle index, which defined sarcopenia (SMI < 52.4 cm2/m2 for men and < 38.5 cm2/m2 for women). Images were collected before and after neoadjuvant treatments. RESULTS Sarcopenia in preoperative imaging was prevalent in 92 patients (80%). Median overall survival was 900 days (interquartile range 334-1447) with no difference between sarcopenic (median = 900) and non-sarcopenic (median = 914) groups (p = 0.872). Complication rates did not differ (26.1% vs 32.6%, p = 0.725). A 2.98% decrease in skeletal muscle index during neoadjuvant treatment correlated with poor 2-year survival (log-rank p = 0.04). CONCLUSION Loss of skeletal muscle tissue during neoadjuvant treatment correlates with worse overall survival.
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Affiliation(s)
- Tommi Järvinen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, P.O. Box 340 HUS, FIN-00029, Helsinki, Finland. .,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland.
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, P.O. Box 340 HUS, FIN-00029, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, P.O. Box 340 HUS, FIN-00029, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Jarmo Salo
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, P.O. Box 340 HUS, FIN-00029, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, P.O. Box 340 HUS, FIN-00029, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
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23
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Feng F, Zheng G, Guo X, Liu Z, Xu G, Wang F, Wang Q, Guo M, Lian X, Zhang H. Impact of body mass index on surgical outcomes of gastric cancer. BMC Cancer 2018; 18:151. [PMID: 29409475 PMCID: PMC5801809 DOI: 10.1186/s12885-018-4063-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/29/2018] [Indexed: 12/14/2022] Open
Abstract
Background The association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, postoperative complications and prognosis of gastric cancer. Methods From October 2008 to March 2015, 1210 gastric cancer patients treated with D2 gastrectomy were enrolled in the present study. Patients were divided into three groups: low BMI group (BMI < 18.5 Kg/m2), normal BMI group (18.5 Kg/m2 ≤ BMI < 25.0 Kg/m2) and high BMI group (BMI ≥ 25.0 Kg/m2). Clinicopathological characteristics and prognosis of patients were recorded and analyzed. Propensity score matching was used to match patients in the three groups. Results There were 107 patients in low BMI group (8.9%), 862 patients in normal BMI group (71.2%) and 241 patients in high BMI group (19.95%). Before matching, BMI was inversely associated with tumor size, tumor depth, lymph node metastasis (LNM) and tumor stage (all P < 0.05). After matching, the clinicopathological features were all comparable among the three groups (all P > 0.05). High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes (all P < 0.05). For postoperative complications, low BMI was associated with decreased rate of postoperative fever (P = 0.025). Age, BMI, tumor size, Borrmann type, pathological type, type of gastrectomy, tumor depth, LNM and tumor stage were risk factors for the prognosis of gastric cancer. Multivariate analysis showed that only BMI, tumor size, tumor depth and LNM were independent prognostic factors. The overall survival of patients with low BMI was significantly worse than patients with normal (P < 0.05) or high BMI (P < 0.05). However, the overall survival was comparable between patients with normal and high BMI (P > 0.05). Conclusions BMI was inversely associated with tumor size, tumor depth, LNM and tumor stage. High BMI was associated with increased blood loss and operation time, and deceased number of retrieved lymph nodes. Low BMI was associated with decreased rate of postoperative fever and decreased survival.
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Affiliation(s)
- Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiaohua Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Fei Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.,Department of General Surgery, No. 534 Hospital of PLA, West Lichun Road, Luoyang, Henan, 471000, China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.,Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, Henan, 454000, China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
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24
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Yu Z, Li S, Liu D, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Liu Y, Zhi X, Yan T, Zhang X, Gong L, Zhang H, Downs JB, Villamizar N, Gao S, He J. Society for Translational Medicine Expert Consensus on the prevention and treatment of postoperative pulmonary infection in esophageal cancer patients. J Thorac Dis 2018; 10:1050-1057. [PMID: 29607180 DOI: 10.21037/jtd.2018.01.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100730, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi'an 710038, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200030, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Ti Tong
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130062, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110043, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130062, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - John B Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | - Nestor Villamizar
- Department of Thoracic and Cardiac Surgery, University of Miami Jackson Memorial Hospital, Miami, FL, USA
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Excessive Pretreatment Weight Loss Is a Risk Factor for the Survival Outcome of Esophageal Carcinoma Patients Undergoing Radical Surgery and Postoperative Adjuvant Chemotherapy. Can J Gastroenterol Hepatol 2018; 2018:6075207. [PMID: 29623265 PMCID: PMC5830280 DOI: 10.1155/2018/6075207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prognostic values of weight loss and body mass index (BMI) in esophageal carcinoma remain controversial. This study aimed to evaluate the impacts of weight loss on the survival of patients undergoing radical surgery and adjuvant chemotherapy. METHODS The medical records of 189 consecutive patients with nonmetastatic esophageal carcinoma treated in our hospital between January 2012 and December 2013 were reviewed, and 121 patients were included for analysis. RESULTS Kaplan-Meier analysis revealed that the 3-year overall survival rate was significantly higher in the low pretreatment weight loss (pre-LWL) group than in the high pretreatment weight loss (pre-HWL) group (P < 0.001). In addition, the 3-year overall survival rate of normal weight group was higher than that of overweight and underweight groups (P = 0.007). Multivariate Cox proportional hazards analysis showed that pre-LWL group had a significantly better 3-year overall survival than pre-HWL group (P = 0.027, HR = 1.89, and 95% CI = 1.07-3.32). pN stage and age were also the survival prognostic factors. CONCLUSIONS Our study showed that low pretreatment weight loss predicted a better survival outcome in the esophageal carcinoma patients with radical surgery and adjuvant chemotherapy. However, BMI and weight loss during treatment had no impact on the survival outcome.
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26
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Ri M, Aikou S, Seto Y. Obesity as a surgical risk factor. Ann Gastroenterol Surg 2017; 2:13-21. [PMID: 29863119 PMCID: PMC5881295 DOI: 10.1002/ags3.12049] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/14/2017] [Indexed: 12/15/2022] Open
Abstract
In recent years, both the actual number of overweight/obese individuals and their proportion of the population have steadily been rising worldwide and obesity-related diseases have become major health concerns. In addition, as obesity is associated with an increased incidence of gastroenterological cancer, the number of obese patients has also been increasing in the field of gastroenterological surgery. While the influence of obesity on gastroenterological surgery has been widely studied, very few reports have focused on individual organs or surgical procedures, using a cross-sectional study design. In the present review, we aimed to summarize the impacts of obesity on surgeries for the esophagus, stomach, colorectum, liver and pancreas. In general, obesity prolongs operative time. As to short-term postoperative outcomes, obesity might be a risk for certain complications, depending on the procedure carried out. In contrast, it is possible that obesity doesn't adversely impact long-term surgical outcomes. The influences of obesity on surgery are made even more complex by various categories of operative outcomes, surgical procedures, and differences in obesity among races. Therefore, it is important to appropriately evaluate perioperative risk factors, including obesity.
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Affiliation(s)
- Motonari Ri
- Department of Gastrointestinal Surgery Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery Graduate School of Medicine The University of Tokyo Tokyo Japan
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Sarcopenia/Muscle Mass is not a Prognostic Factor for Short- and Long-Term Outcome After Esophagectomy for Cancer. World J Surg 2017; 40:2698-2704. [PMID: 27272482 PMCID: PMC5073118 DOI: 10.1007/s00268-016-3603-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Recent studies have suggested that sarcopenia is a prognostic
risk indicator of postoperative complications and predicts survival in cancer patients. The aim of this study is to investigate whether sarcopenia is associated with postoperative short-term outcome (morbidity and mortality) and long-term survival in patients undergoing esophagectomy for cancer after neoadjuvant chemoradiotherapy. Methods All patients who underwent neoadjuvant chemoradiotherapy followed by esophagectomy for cancer, and of whom an adequate CT scan was available, were included in the current study. The presence of sarcopenia was defined by CT imaging using cut-off values of the total cross-sectional muscle tissue measured transversely at the third lumbar level. Results A total number of 120 patients were eligible for analysis. Almost half of the patients (N = 54, 45 %) were classified as having sarcopenia; 24 sarcopenic patients (44 %) had overweight and 5 sarcopenic patients (9 %) were obese. Overall morbidity and mortality rate did not differ significantly between sarcopenic and non-sarcopenic patients, nor did long-term overall or disease-free survival. Also sarcopenic obesity was not associated with worse outcome. Conclusion The presence of sarcopenia was not associated with a negative short- and long-term outcome in this selected group of esophageal cancer patients after neoadjuvant chemoradiotherapy followed by esophagectomy.
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28
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Positive Effect of Higher Adult Body Mass Index on Overall Survival of Digestive System Cancers Except Pancreatic Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1049602. [PMID: 28948163 PMCID: PMC5602622 DOI: 10.1155/2017/1049602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 02/08/2023]
Abstract
High body mass index (BMI) has been inconsistently associated with overall survival (OS) of digestive system cancers (DSCs). This meta-analysis was conducted to investigate whether high BMI was associated with DSCs prognosis. 34 studies were accepted, with a total of 23,946 DSC cases. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) for OS in BMI categories from individual studies were extracted and pooled by random-effect model. The overall HR of DSCs except pancreatic cancer for OS of adult overweight cases was 0.76 (95% CI = 0.67–0.85). DSC individuals except pancreatic cancer with adult obesity were at decreased risk for OS (HR = 0.85, 95% CI = 0.72–0.98). Among DSC patients except pancreatic cancer, the overall HR for the highest versus the lowest BMI category was 0.82 (95% CI = 0.71–0.92). Additionally, comparing the highest and lowest BMI categories, the combined HR of pancreatic cancer was 1.22 (95% CI = 1.01–1.43). Our meta-analysis suggested an increased OS among adult overweight and obese DSC survivors except pancreatic cancer. Overweight and obesity in adulthood may be important prognostic factors that indicate an increased survival from DSC patients except pancreatic cancer.
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29
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Shen S, Araujo JL, Altorki NK, Sonett JR, Rodriguez A, Sungur-Stasik K, Spinelli CF, Neugut AI, Abrams JA. Variation by stage in the effects of prediagnosis weight loss on mortality in a prospective cohort of esophageal cancer patients. Dis Esophagus 2017; 30:1-7. [PMID: 28859366 PMCID: PMC6036662 DOI: 10.1093/dote/dox073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Indexed: 12/11/2022]
Abstract
Cancer cachexia is increasingly recognized as a poor prognostic marker for various tumor types. Weight loss in esophageal cancer is multifactorial, as patients with bulky tumors also have reduced ability to eat. We aimed to investigate the relationship between prediagnosis weight loss and mortality in esophageal cancer and to determine whether these associations vary with tumor stage. We conducted a prospective cohort study of esophageal cancer patients at two tertiary centers. We recorded baseline patient characteristics including medications, smoking, body mass index, and weight loss in the year prior to diagnosis, and collected data on treatment and outcomes. We used Cox regression modeling to determine the associations between percent weight loss and outcomes. The main outcome of interest was all-cause mortality; secondary endpoints were esophageal cancer-specific mortality and development of metastases. We enrolled 134 subjects, the majority of whom had adenocarcinoma (82.1%); median percent weight loss was 4.7% (IQR: 0%-10.9%). Increasing percent weight loss was not associated with all-cause mortality (ptrend = 0.36). However, there was evidence of significant interaction by tumor stage (p = 0.02). There was a strong and significant association between prediagnosis weight loss and mortality in patients with T stages 1 or 2 (adjusted HR 8.26 for highest versus lowest tertile, 95%CI 1.11-61.5, ptrend = 0.03) but not for T stages 3 or 4 (ptrend = 0.32). Body mass index one year prior to diagnosis was not associated with mortality. Prediagnosis weight loss was associated with increased all-cause mortality only in patients with early stage esophageal cancer. This suggests that tumor-related cachexia can occur early in esophageal cancer and represents a poor prognostic marker.
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Affiliation(s)
- S. Shen
- Department of Medicine, Columbia University Medical Center
| | - J. L. Araujo
- Veterans' Administration New York Harbor Healthcare System, Brooklyn, New York, USA
| | - N. K. Altorki
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York
| | - J. R. Sonett
- Thoracic Surgery, Columbia University Medical Center
| | - A. Rodriguez
- Department of Medicine, Columbia University Medical Center
| | | | - C. F. Spinelli
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York
| | - A. I. Neugut
- Department of Medicine, Columbia University Medical Center
| | - J. A. Abrams
- Department of Medicine, Columbia University Medical Center
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30
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Khan MN, Russo J, Spivack J, Pool C, Likhterov I, Teng M, Genden EM, Miles BA. Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery. JAMA Otolaryngol Head Neck Surg 2017; 143:574-579. [PMID: 28301644 PMCID: PMC5824233 DOI: 10.1001/jamaoto.2016.4304] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/13/2016] [Indexed: 12/15/2022]
Abstract
Importance Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity. Objective To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery. Design, Setting, and Participants This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014. Main Outcomes and Measures The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0). Results Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92). Conclusions and Relevance Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
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Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jack Russo
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Spivack
- Department of Health Policy and Statistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Pool
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ilya Likhterov
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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31
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Wightman SC, Posner MC, Patti MG, Ganai S, Watson S, Prachand V, Ferguson MK. Extremes of body mass index and postoperative complications after esophagectomy. Dis Esophagus 2017; 30:1-6. [PMID: 28375438 DOI: 10.1093/dote/dow006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/20/2016] [Indexed: 12/11/2022]
Abstract
Obesity has been variously associated with reduced or similar rates of postoperative complications compared to normal weight patients undergoing esophagectomy for cancer. In contrast, little is known about esophagectomy risks in the underweight population. The relationship between the extremes of body mass index (BMI) and postoperative complications after esophagectomy was evaluated. Consecutive esophagectomy patients (2000-2013) were reviewed. The patients were stratified based on BMI at the time of diagnosis: underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), obese I (30-34.9), and obese II or III (≥35). Hospital length of stay as well as postoperative complications and their accordion severity grading were evaluated according to the BMI category. Of 388 patients, 78.6% were male with a median age of 62 years at the time of operation. Pathologic cancer stage was 0 to I in 53%. BMI distribution was as follows: 5.6% underweight, 28.7% normal, 31.4% overweight, 22.8% obese I, and 11.5% obese II or III. Performance status was 0 or 1 in 99.2%. Compared to normal BMI patients, underweight patients had increased pulmonary complications (odds ratio (OR) 3.32, P = 0.014) and increased other postoperative complications (OR 3.00, P = 0.043). Patients who were overweight did not have increased complications compared to normal BMI patients. BMI groups did not differ in mortality rates or complication accordion severity grading. Hospital length of stay trended toward a longer duration in the underweight population (P = 0.06). Underweight patients are at increased risk for postoperative pulmonary and other complications. Underweight patients may benefit from preoperative nutritional repletion and mitigation for sarcopenia. Aggressive postoperative pulmonary care may help reduce complications in these patients. In contrast, the operative risk in overweight and obese patients is similar to normal BMI patients.
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Affiliation(s)
- S C Wightman
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - M C Posner
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.,Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | - M G Patti
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - S Ganai
- Department of Surgery, Southern Illinois University, Springfield, Illinois, USA
| | - S Watson
- ?Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - V Prachand
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - M K Ferguson
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.,Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois, USA
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32
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Kruhlikava I, Kirkegård J, Mortensen FV, Kjær DW. Impact of Body Mass Index on Complications and Survival after Surgery for Esophageal and Gastro-Esophageal-Junction Cancer. Scand J Surg 2017; 106:305-310. [PMID: 28737095 DOI: 10.1177/1457496916683097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The impact of body mass index on complications and survival in patients undergoing esophagectomy has been extensively studied with conflicting results. In this study, we assess the impact of body mass index on complications and survival following surgery for esophageal and gastro-esophageal-junction cancer in a Danish population. MATERIAL AND METHODS We identified 285 consecutive patients, who underwent curative-intended treatment for esophageal and gastro-esophageal-junction cancer in the period 2003-2010. We manually reviewed the electronic medical records of all patients included in the study. Body mass index was calculated as weight in kilograms divided by height in meters squared. We grouped patients according to their body mass index, using the World Health Organization definition, as underweight (body mass index < 18.5 kg/m2), normal weight (body mass index: 18.5-24.9 kg/m2), overweight (body mass index: 25-29.9 kg/m2), and obese (body mass index ⩽ 30 kg/m2). RESULTS Median age at surgery was 65 years (range: 27-84 years), of which 207 (72.6%) were males. Patients with the lowest body mass index and the obese patients seemed to have a higher frequency of minor complications. Anastomotic leakage occurred in less than 10% of the patients and was equally distributed across the groups as was the other major complications. There were no differences in the 1-, 2-, or 5-year survival rates between the four body mass index groups after adjustment for possible confounders. Five-year survival rates for the four body mass index groups were 31.8%, 28.7%, 27.9%, and 26.1%, respectively. CONCLUSION Body mass index over 30 or under 18.5 does not seem to affect survival rates or the presence of serious postoperative complications following esophagectomy in patients with esophageal and gastro-esophageal-junction cancers not receiving neoadjuvant oncological treatment.
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Affiliation(s)
- I Kruhlikava
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - J Kirkegård
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - F V Mortensen
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
| | - D W Kjær
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, Aarhus, Denmark
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33
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Salem AI, Thau MR, Strom TJ, Abbott AM, Saeed N, Almhanna K, Hoffe SE, Shridhar R, Karl RC, Meredith KL. Effect of body mass index on operative outcome after robotic-assisted Ivor-Lewis esophagectomy: retrospective analysis of 129 cases at a single high-volume tertiary care center. Dis Esophagus 2017; 30:1-7. [PMID: 27149640 DOI: 10.1111/dote.12484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The impact of body weight on outcomes after robotic-assisted esophageal surgery for cancer has not been studied. We examined the short-term operative outcomes in patients according to their body mass index following robotic-assisted Ivor-Lewis esophagectomy at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated body mass index. A retrospective review of all patients who underwent robotic-assisted Ivor-Lewis esophagectomy between April 2010 and June 2013 for pathologically confirmed distal esophageal cancer was conducted. Patient demographics, clinicopathologic data, and operative outcomes were collected. We stratified body mass index at admission for surgery according to World Health Organization criteria; normal range is defined as a body mass index range of 18.5-24.9 kg/m2. Overweight is defined as a body mass index range of 25.0-29.9 kg/m2 and obesity is defined as a body mass index of 30 kg/m2 and above. Statistics were calculated using Pearson's Chi-square and Pearson's correlation coefficient tests with a P-value of 0.05 or less for significance. One hundred and twenty-nine patients (103 men, 26 women) with median age of 67 (30-84) years were included. The majority of patients, 76% (N = 98) received neoadjuvant therapy. When stratified by body mass index, 28 (22%) were normal weight, 56 (43%) were overweight, and 45 (35%) were obese. All patients had R0 resection. Median operating room time was 407 (239-694) minutes. When stratified by body mass index, medians of operating room time across the normal weight, overweight and obese groups were 387 (254-660) minutes, 395 (310-645) minutes and 445 (239-694), respectively. Median estimated blood loss (EBL) was 150 (25-600) cc. When stratified by body mass index, medians of EBL across the normal weight, overweight and obese groups were 100 (50-500) cc, 150 (25-600) cc and 150 (25-600), respectively. Obesity significantly correlated with longer operating room time (P = 0.05) but without significant increased EBL (P = 0.348). Among the three body mass index groups there was no difference in postoperative complications including thrombotic events (pulmonary embolism and deep venous thrombosis) (P = 0.266), pneumonia (P = 0.189), anastomotic leak (P = 0.090), wound infection (P = 0.390), any cardiac events (P = 0.793) or 30 days mortality (P = 0.414). Our data study demonstrates that patients with esophageal cancer and an elevated body mass index undergoing robotic-assisted Ivor-Lewis esophagectomy have increased operative times but no significantly increased EBL during the procedure. Other potential morbidities did not differ with the robotic approach.
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Affiliation(s)
- Ahmed I Salem
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Matthew R Thau
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Andrea M Abbott
- Department of Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Nadia Saeed
- Department of Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Khaldoun Almhanna
- Department of Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Richard C Karl
- Department of Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kenneth L Meredith
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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34
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The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer. BMC Gastroenterol 2016; 16:142. [PMID: 28003023 PMCID: PMC5175390 DOI: 10.1186/s12876-016-0549-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/22/2016] [Indexed: 01/04/2023] Open
Abstract
Background Body mass index (BMI), resting energy expenditure (REE) and fasting blood glucose (FBG) are major preoperative assessments of patients’ nutrition and metabolic state. The relations and effects of these indices on esophageal cancer patients’ postoperative short-term and long-term outcomes remain controversial and unclear. We aimed to study the impact of BMI, REE and FBG in esophageal cancer patients undergoing esophagectomy. Methods Three hundred and six esophageal cancer patients who underwent esophagectomy were observed retrospectively. Clinical characteristics, postoperative complications and survival analysis were compared among different BMI, REE and FBG groups. Results There were significant linear relationships between REE, BMI and FBG indices, patients with low BMI tended to have low REE (p < 0.001) and low FBG (p = 0.003). No significant difference was found in case of mortality and postoperative complications among different groups. Low BMI (X2 = 6.141, p = 0.046), REE (X2 = 6.630, p = 0.010) and FBG (X2 = 5.379, p = 0.020) were related to poor survival. FBG ≤90 mg/dL was independently associated with poor survival (HR = 0.695; 95 % CI 0.489–0.987, p = 0.042). BMI and REE came to be stronger prognostic factors on lymph node-negative patients and proved to be independent prognostic indicators (HR = 0.540; 95 % CI 0.304–0.959, p = 0.035 and HR = 0.457; 95 % CI 0.216–0.967, p = 0.041, respectively). Conclusions BMI, REE and FBG are important prognostic factors in patients with esophageal cancer undergoing esophagectomy and preoperative evaluation of these indices help to determine the prognosis in these patients.
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Abstract
The prevalence of overweight (body mass index [BMI], 25 to 29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2) have increased dramatically in the United States. Because increasing BMI is associated with the development of multiple different cancer types, including most GI cancers, providers will frequently encounter patients with GI cancer who are overweight or obese. Mounting evidence associates overweight and/or obesity with worsened prognosis in multiple GI cancers, including esophageal, gastric, hepatocellular, pancreatic, and colorectal. However, these data are observational and may be subject to bias and/or confounding. Furthermore, in some cancer types, the associations between BMI and outcomes is not linear, where overweight and class I obese patients may have an improvement in outcome. This report provides a brief highlight of existing studies that have linked overweight and/or obesity to prognosis in GI cancer; provides recommendations on best management practices; and discusses limitations, controversies, and future directions in this rapidly evolving area. There are multiple areas of promise that warrant continued investigation: What are the comparative contributions of energy balance, including weight, dietary patterns, and physical activity on cancer prognosis? What are the specific physiologic pathways that mediate the relationship between energy balance and prognosis? What is the relationship between low muscle mass (sarcopenia) or sarcopenic obesity and cancer prognosis? Are there subsets of patients for whom purposefully altering energy balance would be deleterious to prognosis? This area is rich with opportunities to understand how states of energy (im)balance can be favorably altered to promote healthy survivorship.
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Affiliation(s)
- Justin C. Brown
- Justin C. Brown, University of Pennsylvania, Philadelphia, PA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA
| | - Jeffrey A. Meyerhardt
- Justin C. Brown, University of Pennsylvania, Philadelphia, PA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA
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Ji W, Zheng W, Li B, Cao C, Mao W. Influence of body mass index on the long-term outcomes of patients with esophageal squamous cell carcinoma who underwent esophagectomy as a primary treatment: A 10-year medical experience. Medicine (Baltimore) 2016; 95:e4204. [PMID: 27442643 PMCID: PMC5265760 DOI: 10.1097/md.0000000000004204] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We explored the influence of body mass index (BMI) on long-term outcomes in patients with esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy as a primary treatment. BMI is a risk factor for development of esophageal cancer. However, the details of the relationship between BMI and cancer prognosis remains unclear. Patients who underwent esophagectomy as an initial treatment in 2000 to 2009 period were included. The patients were divided into 3 groups according to Asian-specific BMI cut-offs. The associations between BMI and long-term outcomes were explored. This study included 1082 ESCC patients between 2000 and 2009; all the patients underwent esophagectomy. The median overall survival (OS) of the BMI <18.5, 18.5 ≤ BMI <23, and BMI ≥23 kg/m groups were 21, 24, and 29.5 months, respectively; they differed significantly (P = 0.005). The 5-year survival rates of the 3 groups were 24.6%, 30.4%, and 35.3%, respectively. Multivariate analysis showed that lower BMI was an independent risk factor for a shorter OS (18.5 ≤ BMI <23 kg/m vs. BMI ≥23 kg/m, hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 1.00-1.40, P = 0.054, BMI <18.5 kg/m vs. BMI ≥23 kg/m, HR = 1.38; 95% CI = 1.09-1.75, P = 0.007). The better OS of the BMI ≥23 kg/m patients remained statistically significant in never-smoking patients (P < 0.05). In conclusion, patients with BMIs ≥23 kg/m experienced better OS, and multivariate analysis further indicated that BMI ≥23 kg/m was an independent predictor of survival. When stratified by smoking status, BMI ≥23 kg/m was still a factor in better OS among never smokers.
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Affiliation(s)
- Wenhao Ji
- Zhejiang Key Laboratory of Radiation Oncology
| | | | | | - Caineng Cao
- Zhejiang Key Laboratory of Radiation Oncology
| | - Weimin Mao
- Department of thoracic surgery, Zhejiang Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, China
- Correspondence: Weimin Mao, MD, Department of thoracic surgery, Zhejiang Cancer Hospital, No. 1 East Banshan Road, Gongshu District Hangzhou 310022 China (e-mail: )
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Chen SY, Molena D, Stem M, Mungo B, Lidor AO. Post-discharge complications after esophagectomy account for high readmission rates. World J Gastroenterol 2016; 22:5246-5253. [PMID: 27298567 PMCID: PMC4893471 DOI: 10.3748/wjg.v22.i22.5246] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/05/2016] [Accepted: 04/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify rates of post-discharge complications (PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.
METHODS: We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication (Group 1), only pre-discharge complication (Group 2), and PDC patients (Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing post-discharge complication, and risk ratios were estimated.
RESULTS: 4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay (LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection (41.0% vs 19.3%, P < 0.001), venous thromboembolism (16.3% vs 8.9%, P < 0.001), and organ space surgical site infection (17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation (39.5% vs 22.4%, P < 0.001) and readmission (66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI (18.5-25).
CONCLUSION: PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient’s health pre-discharge, with possible prevention programs at discharge.
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Van De Voorde L, Janssen L, Larue R, Houben R, Buijsen J, Sosef M, Vanneste B, Schraepen MC, Berbée M, Lambin P. Can metformin improve ‘the tomorrow’ of patients treated for oesophageal cancer? Eur J Surg Oncol 2015; 41:1333-9. [DOI: 10.1016/j.ejso.2015.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/24/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023] Open
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Guo Z, Zhang J, Jiang JH, Li LQ, Xiang BD. Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy. PLoS One 2015; 10:e0125649. [PMID: 25965529 PMCID: PMC4428764 DOI: 10.1371/journal.pone.0125649] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/23/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Whether obesity affects surgical outcomes in patients with hepatocellular carcinoma (HCC) is controversial. Here we retrospectively evaluated the impact of obesity on outcomes in HCC patients after curative hepatectomy. METHODS Patients with Child-Pugh A liver function who underwent curative hepatectomy between 2006 and 2010 were categorized as obese (BMI ≥25 kg/m2, n = 68) and non-obese (<25 kg/m2, n = 242). To reduce interference from baseline differences between the two groups, propensity score-matched analysis was performed in the ratio 1:2 using a caliper width of 0.1. Surgical outcomes were compared for 61 obese and 115 non-obese patients. RESULTS Obese patients had higher levels of albumin and aspartate aminotransferase, and more solitary tumors compared to the non-obese patients (all P<0.05). In the propensity-matched cohort, baseline characteristics did not differ between the two groups (all P>0.05). Obese and non-obese patients had comparable 30-day mortality (1.6% vs. 2.6%, P = 1.000), 90-day mortality (3.3% vs. 4.3%, P = 1.000), and incidence of postoperative complications (19.7% vs. 18.3%, P = 0.819). Overall survival at 1, 3, and 5 years was similar for obese patients (83.6%, 63.6%, 41.6%) as for non-obese patients (80.9%, 65.9%, 49.1%; P = 0.358). Disease-free survival at 1, 3, and 5 years was also similar for obese patients (71.5%, 36.3%, 24.3%) as for non-obese ones (60.2%, 43.7%, 27.7%; P = 0.969). CONCLUSION Our propensity score-matched analysis strengthens the case that obesity does not adversely affect surgical outcomes of HCC patients undergoing curative hepatectomy.
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Affiliation(s)
- Zhe Guo
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Wuhan, P.R. China
| | - Jun Zhang
- Department of Ultrasound, Wuhan NO. 1 Hospital, Wuhan, P.R. China
| | - Jing-Hang Jiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China
- Department of General Surgery, The Second People’s Hospital of Jing Men, Jingmen, P.R. China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China
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Miao L, Chen H, Xiang J, Zhang Y. A high body mass index in esophageal cancer patients is not associated with adverse outcomes following esophagectomy. J Cancer Res Clin Oncol 2015; 141:941-50. [PMID: 25428458 DOI: 10.1007/s00432-014-1878-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/13/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE There is no consensus about the impact of a high BMI on postoperative morbidity and survival after esophagectomy. The aim of this study was to determine the influence of a high BMI on postoperative complications and survival in a large cohort of esophageal cancer patients. METHODS From January 2006 to December 2012, 1,342 consecutive esophageal cancer patients who underwent esophagectomy were included in this study. Patients were divided into three groups: 950 patients were classified as normal BMI (BMI 18.5-24.9 kg/m(2)), 279 were classified as high BMI (BMI ≥ 25 kg/m(2)), and 113 as low BMI (BMI < 18.5 kg/m(2)). Multivariate logistic regression models were used to identify confounding factors associated with postoperative complications. The impact of BMI on overall survival (OS) was estimated by the Kaplan-Meier method and Cox proportional hazard models. RESULTS The predominance of pathological type was esophageal squamous cell carcinoma (n = 1,280, 95.4 %). Overall morbidity, mortality, and hospital stay did not differ among groups. The incidence of pneumonia was higher in patients with high BMI compared with those with normal BMI (14.7 vs. 9.9 %, P = 0.025). However, chylothorax was less frequent in high-BMI group (0.4 % in high-BMI group, 3.1 % in normal group, and 3.5 % in low group, P = 0.011). Logistic regression analysis revealed high BMI was independently associated with decreased incidence of chylothorax [HR 0.86; 95 % confidence interval 0.76-0.97]. Overweight and obese patients had significantly better overall survival than underweight patients (median OS 55.6 vs. 32.5 months, P = 0.013), while the pathological stage was significantly higher in underweight patients (P = 0.001). In multivariate analysis, T status, N status, differentiation grade, and tumor length were identified as independent prognostic factors. CONCLUSION A high BMI is not associated with increased overall morbidity following esophagectomy; moreover, it is associated with decreased incidence of chylothorax. The better overall survival in patients with high BMI compared with those with low BMI might be due to a relatively low pathological stage. A high BMI should therefore not be a relative contraindication for esophagectomy.
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Affiliation(s)
- Longsheng Miao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
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Wang F, Duan H, Cai M, Fu J, Ma G, Yang H, Tan Z, Hu R, Lin P, Zhang X. Prognostic significance of the pN classification supplemented by body mass index for esophageal squamous cell carcinoma. Thorac Cancer 2015; 6:765-71. [PMID: 26557916 PMCID: PMC4632930 DOI: 10.1111/1759-7714.12259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/25/2015] [Indexed: 01/01/2023] Open
Abstract
Background Body mass index (BMI) has been associated with the risk of esophageal cancer. But the influence of BMI on postoperative complications and prognosis has always been controversial. Methods Between 2000 and 2007, 424 patients with esophageal squamous cell carcinoma (ESCC) underwent R0 esophagectomy at our center without neoadjuvant therapy. We performed univariate and multivariate analyses to identify prognostic factors for survival. Results Patients were divided into three groups according to Asian-specific BMI cut-off value: underweight (n = 45), normal weight (n = 228), and overweight and obese (n = 151). Mean follow-up time was 39 months. The five-year overall survival (OS) rate was 19%, 34%, and 42% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). The five-year disease-free survival (DFS) rate was 24%, 41%, and 74% for underweight, normal weight, and overweight and obese, respectively (P < 0.001). Multivariate analysis showed that pT, pN, and BMI were independent prognostic factors for DFS and OS. The C-index to the combined model showed improved predictive ability when compared to the pN classification (0.779 vs. 0.734). Conclusion Preoperative BMI was an independent prognostic factor for OS and DFS. The proposed new prognostic model with the pN classification supplemented by BMI might improve the ability to discriminate ESCC patients’ outcome.
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Affiliation(s)
- Feixiang Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Hao Duan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Muyan Cai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Pathology, Sun Yat-sen University Cancer Center Guangzhou, China
| | - Jianhua Fu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Guowei Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Han Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Zihui Tan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
| | - Ronggui Hu
- Department of Cardio-Thoracic Surgery, Zhongshan People's Hosptial Zhongshan, China
| | - Peng Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China
| | - Xu Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, China ; Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center Guangzhou, China ; Guangdong Esophageal Cancer Research Institute Guangzhou, China
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Hasegawa T, Kubo N, Ohira M, Sakurai K, Toyokawa T, Yamashita Y, Yamazoe S, Kimura K, Nagahara H, Amano R, Shibutani M, Tanaka H, Muguruma K, Ohtani H, Yashiro M, Maeda K, Hirakawa K. Impact of body mass index on surgical outcomes after esophagectomy for patients with esophageal squamous cell carcinoma. J Gastrointest Surg 2015; 19:226-33. [PMID: 25398407 DOI: 10.1007/s11605-014-2686-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with overweight reportedly have more comorbidities, including diabetes mellitus and cardiovascular disease, and longer operating times as well as more blood loss during surgery compared with those with normal weight. However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We hypothesized that overweight has a negative impact on short-term surgical outcomes after esophagectomy for patients with ESCC. METHODS A total of 304 patients who underwent transthoracic esophagectomy for ESCC were included in this study. Body mass index (BMI) was classified into three categories, <18.49, 18.50-24.99, and >25.00 (kg/m(2)), defined as low, normal, and high BMI, respectively, according to the World Health Organization criteria. We investigated the association of BMI status with patient demographics and surgical outcomes after esophagectomy for patients with ESCC. In addition, overall survival and relapse-free survival stratified by BMI were compared. RESULTS Fifty-nine (19.4 %) and 41 (13.4 %) patients were classified to low BMI and high BMI, respectively. The high-BMI group had significantly higher comorbidity rates of diabetes mellitus (p < 0.01) and anastomotic leakage (p = 0.011) than the normal-BMI group. There were no significant association between high BMI and another various complications except for an anastomotic leakage, severe complications defined by Clavien-Dindo classification and in-hospital mortality. In multivariate analysis, high BMI was a significant risk factor for anastomotic leakage (p = 0.030, hazard ratio; 3.423, 95%CI; 1.128-10.38). On the other hand, no significant association was observed between low BMI and short surgical outcomes. There were no significant differences in overall and relapse-free survival among the three BMI groups in univariate and multivariate analysis (p = 0.128 and p = 0.584, respectively). CONCLUSION The surgical treatment should not be denied for patients with ESCC due to overweight and underweight. However, intraoperative prevention and postoperative careful monitoring for anastomotic leakage might be required after esophagectomy for overweight patients with ESCC.
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Affiliation(s)
- Tsuyoshi Hasegawa
- Department of Surgical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Wang J, Myles B, Wei C, Chang JY, Hofstetter WL, Ajani JA, Swisher SG, Cox JD, Komaki R, Liao Z, Lin SH. Obesity and outcomes in patients treated with chemoradiotherapy for esophageal carcinoma. Dis Esophagus 2014; 27:168-75. [PMID: 23621168 PMCID: PMC3740061 DOI: 10.1111/dote.12074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Body mass index (BMI) is a risk factor for comorbid illnesses and cancer development. It was hypothesized that obesity status affects disease outcomes and treatment-related toxicities in esophageal cancer patients treated with chemoradiotherapy (CRT). From March 2002 to April 2010, 405 patients with non-metastatic esophageal carcinoma at MD Anderson Cancer Center treated with either definitive or neoadjuvant CRT were retrospectively analyzed. Patients were categorized as either obese (BMI ≥ 25 kg/m(2) ) or nonobese (BMI < 25 kg/m(2) ). Progression-free survival and overall survival times were examined using the Kaplan-Meier method and Cox proportional hazards regression analysis. One hundred fifteen (28.4%) patients were classified as nonobese and 290 (71.6%) as obese. Obese patients were more likely than others to have several comorbid diseases (P < 0.001), adenocarcinoma located distally (P < 0.001), and have undergone surgery (P = 0.004). Obesity was not associated with either worse operative morbidity/mortality (P > 0.05) or worse positron emission tomography tumor response (P = 0.46) on univariate analysis, nor with worse pathologic complete response (P = 0.98) on multivariate analysis. There was also no difference in overall survival, locoregional control, or metastasis-free survival between obese and nonobese patients (P = 0.86). However, higher BMI was associated with reduced risk of chemoradiation-induced high-grade esophagitis (P = 0.021), esophageal stricture (P < 0.001), and high-grade hematologic toxicity (P < 0.001). In esophageal cancer patients treated with CRT, obesity is not predictive of poorer disease outcomes or operative morbidities; instead, data suggest it may be associated with decreased risk of acute chemotherapy- and radiotherapy-related treatment toxicities.
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Affiliation(s)
- Jingya Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bevan Myles
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caimiao Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L. Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G. Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James D. Cox
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chen M, Huang J, Zhu Z, Zhang J, Li K. Systematic review and meta-analysis of tumor biomarkers in predicting prognosis in esophageal cancer. BMC Cancer 2013; 13:539. [PMID: 24206575 PMCID: PMC3828582 DOI: 10.1186/1471-2407-13-539] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/20/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is a frequently occurring cancer with poor prognosis despite combined therapeutic strategies. Many biomarkers have been proposed as predictors of adverse events. We sought to assess the prognostic value of biomarkers in predicting the overall survival of esophageal cancer and to help guide personalized cancer treatment to give patients the best chance at remission. METHODS We conducted a systematic review and meta-analysis of the published literature to summarize evidence for the discriminatory ability of prognostic biomarkers for esophageal cancer. Relevant literature was identified using the PubMed database on April 11, 2012, and conformed to the REMARK criteria. The primary endpoint was overall survival and data were synthesized with hazard ratios (HRs). RESULTS We included 109 studies, exploring 13 different biomarkers, which were subjected to quantitative meta-analysis. Promising markers that emerged for the prediction of overall survival in esophageal squamous cell cancer included VEGF (18 eligible studies, n=1476, HR=1.85, 95% CI, 1.55-2.21), cyclin D1 (12 eligible studies, n=1476, HR=1.82, 95% CI, 1.50-2.20), Ki-67 (3 eligible studies, n=308, HR=1.11, 95% CI, 0.70-1.78) and squamous cell carcinoma antigen (5 eligible studies, n=700, HR=1.28, 95% CI, 0.97-1.69); prognostic markers for esophageal adenocarcinoma included COX-2 (2 eligible studies, n=235, HR=3.06, 95% CI, 2.01-4.65) and HER-2 (3 eligible studies, n=291, HR=2.15, 95% CI, 1.39-3.33); prognostic markers for uncategorized ECs included p21 (9 eligible studies, n=858, HR=1.27, 95% CI, 0.75-2.16), p53 (31 eligible studies, n=2851, HR=1.34, 95% CI, 1.21-1.48), CRP (8 eligible studies, n=1382, HR=2.65, 95% CI, 1.64-4.27) and hemoglobin (5 eligible studies, n=544, HR=0.91, 95% CI, 0.83-1.00). CONCLUSIONS Although some modest bias cannot be excluded, this review supports the involvement of biomarkers to be associated with EC overall survival.
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Affiliation(s)
- Meilan Chen
- Department of Preventive Medicine, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong 515041, China
| | - Jizheng Huang
- Department of Preventive Medicine, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong 515041, China
| | - Zhenli Zhu
- Department of Preventive Medicine, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong 515041, China
| | - Jun Zhang
- Department of Preventive Medicine, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong 515041, China
| | - Ke Li
- Department of Preventive Medicine, Shantou University Medical College, No.22 Xinling Road, Shantou, Guangdong 515041, China
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The impact of body mass index on complication and survival in resected oesophageal cancer: a clinical-based cohort and meta-analysis. Br J Cancer 2013; 109:2894-903. [PMID: 24201750 PMCID: PMC3844915 DOI: 10.1038/bjc.2013.666] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/23/2013] [Accepted: 10/02/2013] [Indexed: 12/11/2022] Open
Abstract
Background: Body mass index (BMI) has been associated with the risk of oesophageal cancer. But the influence of BMI on postoperative complication and prognosis has always been controversial. Methods: In total, 2031 consecutive patients who underwent oesophagectomy between 1998 and 2008 were classified according to Asian-specific BMI (kg m−2) cutoff values. The impact of BMI on overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazard models. We performed a meta-analysis to examine the association of BMI with OS and postoperative complication. Results: Patients with higher BMI had more postoperative complication (P=0.002), such as anastomotic leakage (P=0.016) and cardiovascular diseases (P<0.001), but less incidence of chylous leakage (P=0.010). Logistic regression analysis showed that BMI (P=0.005) was a confounding factor associated with postoperative complication. Multivariate analysis showed that overweight and obese patients had a more favourable survival than normal weight patients (HR (hazard ratio) = 0.80, 95% CI (confidence interval): 0.70–0.92, P=0.001). Subgroup analysis showed that the association with higher BMI and increased OS was observed in patients with oesophageal squamous cell carcinoma (ESCC) (P<0.001), oesophageal adenocarcinoma (EA) (P=0.034), never-smoking (P=0.035), ever-smoking (P=0.035), never alcohol consumption (P=0.005), weight loss (P=0.003) and advanced pathological stage (P<0.001). The meta-analysis further corroborated that higher BMI was associated with increased complication of anastomotic leakage (RR (risk ratio)=1.04, 95% CI: 1.02–1.06, P=0.001), wound infection (RR=1.03, 95% CI: 1.00–1.05, P=0.031) and cardiovascular diseases (RR=1.02, 95% CI: 1.00–1.05, P=0.039), but decreased incidence of chylous leakage (RR=0.98, 95% CI: 0.96–0.99, P<0.001). In addition, high BMI could significantly improved OS (HR=0.78, 95% CI: 0.71–0.85, P<0.001). Conclusion: Preoperative BMI was an independent prognostic factor for survival, and strongly associated with postoperative complications in oesophageal cancer.
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Wong JY, Shridhar R, Almhanna K, Hoffe SE, Karl RC, Meredith KL. The impact of body mass index on esophageal cancer. Cancer Control 2013; 20:138-43. [PMID: 23571704 DOI: 10.1177/107327481302000207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Surgeons are increasingly operating on patients who are overweight or obese. The influence of obesity on surgical and oncologic outcomes has only recently been addressed. We focus this review on obesity and its impact on esophageal cancer. METHODS Recent literature and our own institutional experience were reviewed to determine the impact of body mass index on the perioperative and long-term outcomes of patients with esophageal cancer. RESULTS With few exceptions, no significant differences were seen in perioperative outcomes or survival in patients treated for esophageal cancer when stratified by body mass index. CONCLUSIONS Although obesity poses increased operative challenges to the surgeon, surgical and oncologic outcomes remain unchanged in obese patients compared with patients who are not obese.
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Affiliation(s)
- Joyce Y Wong
- Surgical Oncology Fellowship Program, H Lee Moffitt Cancer Center, Tampa 33612, FL, USA
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Sun P, Zhang F, Chen C, An X, Li YH, Wang FH, Zhu ZH. Comparison of the prognostic values of various nutritional parameters in patients with esophageal squamous cell carcinoma from Southern China. J Thorac Dis 2013; 5:484-91. [PMID: 23991306 DOI: 10.3978/j.issn.2072-1439.2013.08.38] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Nutritional evaluation is important for patients with esophageal cancer, but the impact of undernutrition on outcome of those patients is not well elucidated. Our aim is to assess the impact of baseline nutritional status on overall survival (OS) in Chinese patients with esophageal squamous cell carcinoma (ESCC) and to detect a most appropriate indicator for nutritional evaluation. METHODS 502 patients from Southern China diagnosed as ESCC in Sun Yat-Sen University Cancer Center were included. A series of nutritional indicators were introduced to evaluate the baseline nutritional status. Kaplan-Meier method was used to estimate the 5-year OS and the log-rank test was used to determine the survival differences. Cox proportional hazards model was used in the univariate and multivariate analyses of OS. RESULTS With a median follow up time of 30 months, the median OS for the entire patient group was 37.3 months with the 5-year OS rate of 43.0%. Only performance status, AJCC 6th stage and body mass index (BMI) were the independent prognostic factors in multivariate analysis of OS. The median OS for patients with BMI less than 18.5, patients with BMI within 18.5-24.9 and patients with BMI more than 24.9 were 19.2, 43.2 and 51.6 months, respectively, with the 5-year OS rates of 25.2%, 46.1% and 48.1% (P<0.001). Patients with BMI <18.5 tended to present with a more advanced stage disease and a poorer tumor grade. CONCLUSIONS Baseline nutritional status is predictive of OS in Chinese patients with ESCC. BMI is a steady indicator for nutritional evaluation and a sensitive prognostic parameter for ESCC patients. Treatment optimization in ESCC patients with low BMI should integrate the modalities and individual nutritional support.
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Affiliation(s)
- Peng Sun
- State Key Laboratory of Oncology in South China, Guangzhou 510060, P. R. China; ; Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, P. R. China
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Melis M, Weber J, Shridhar R, Hoffe S, Almhanna K, Karl RC, Meredith KL. Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review. BMJ Open 2013; 3:bmjopen-2012-001336. [PMID: 23645908 PMCID: PMC3646172 DOI: 10.1136/bmjopen-2012-001336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after oesophagectomy for adenocarcinoma of the oesophagus. DESIGN Retrospective database review. SETTING Single institution high volume oncological tertiary care referral centre. PARTICIPANTS From our comprehensive oesophageal cancer database consisting of 709 patients, we stratified patients according to BMI: 155 normal-weight (BMI 20-24), 198 overweight (BMI 25-29) and 187 obese (BMI ≥30) patients. INTERVENTIONS All patients underwent oesophagectomy for cancer. PRIMARY AND SECONDARY OUTCOME MEASURES Incidences of preoperative risk factors and perioperative complications in each group were analysed. RESULTS The patient cohort consisted of 474 men and 66 women with a mean age of 64.3 years (28-86). They were similar in terms of demographics and comorbidities, with the exception of a younger age (65.2 vs 65.4 vs 62.5 years, p=0.0094), and a higher incidence of diabetes (9.1% vs 13.2% vs 22.7%, p=0.001), hiatal hernia (16.8% vs 17.8% vs 28.8%, p=0.009) and Barrett oesophagus (24.7% vs 25.4% vs 36.2%, p=0.025) for obese patients. The type of surgery performed, overall blood loss, extent of lymphadenectomy, R0 resections and complications were not influenced by BMI on univariate and multivariate analysis. CONCLUSIONS In our experience, patients with an elevated BMI and oesophageal adenocarcinoma do not experience an increase in morbidity and mortality after oesophagectomy as stated in previous reports, when performed at a high volume centre. Additionally, BMI did not affect the quality of oncological resection as determined by number of harvested lymph-nodes and rates of R0 resections. TRIAL REGISTRATION MCC 15030, IRB 105286.
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Affiliation(s)
- Marcovalerio Melis
- Department of Surgery, New York University Medical School, New York, New York, USA
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Abstract
Progress of the last five years regarding "Obesity and Cancer" with preference to cohort studies was reviewed for cancer of the colorectum, breast, endometrium, renal cell, and adenocarcinomas of the esophagus and compared to the knowledge reviewed in the year 2008. The new studies are mostly confirming what has been known also 5 years ago. Gender seems to play a role in colorectal cancer in that risk due to body fatness is much lower in women than in men. Body fatness at young adulthood is particularly related to risk of renal cancer whereas attained body fatness at a later stage of adulthood is driving the risk for postmenopausal breast and endometrial cancer. Fat distribution is playing a strong role for risk of adenocarcinoma of the esophagus and to a lesser extent also for colon cancer. Prediagnostic body fatness plays also a role in cancer recurrence and survival.
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Affiliation(s)
- Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
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