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

Abstract

Background Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. Methods The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI C 25 kg/m2; n = 432) and low BMI (BMI\25 kg/ m2; n = 1,053) groups, and their clinical outcomes were compared. Results The mean age and proportion of comorbid patients were higher in the high BMI group than in the low BMI group. Postoperative morbidity and mortality did not differ between the high BMI (15.7% and 0.9%) and low BMI (14% and 0.5%) groups (p = 0.37 and p = 0.29). Only the operation time and the number of retrieved lymph nodes were significantly different between the high BMI (242.5 min and 30.4) and low BMI (223.7 min and 32.6) groups (p\0.001 and p = 0.005), especially for male patients undergoing surgery by surgeons who have performed 40 or fewer LAGs. Conclusions High BMI itself may not increase operative morbidity after LAG for gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI. Keywords Body mass index Gastric cancer Gastrectomy Laparoscopy Obesity Laparoscopically assisted gastrectomy (LAG) with regional lymph node (LN) dissection is considered one of the limited treatments for early gastric cancer [1]. Several studies have reported the technical and oncologic safety of laparoscopic gastrectomy [2–4]. Obesity is known to increase the risk for type 2 diabetes, cardiovascular disease, hypertension, and some cancers, including carcinomas of the breast and colon [5]. In the context of surgical procedures, obesity itself is regarded as one of the risk factors for poor outcome after complicated surgical procedures such as gastrectomy with LN dissection [6, 7]. The LAG procedure requires the surgical techniques of both laparoscopy and open gastric cancer surgery. Therefore, the impact of obesity on LAG is expected to be much greater than its impact on open gastrectomy. In fact, several technical disadvantages of LAG for obese patients are anticipated including poorer surgical visibility, blood oozing from soft tissues, a dissection plane hindered by adipose tissue, difficulty with anastomosis, and so forth. To date, studies evaluating the impact of body mass index (BMI) on LAG for gastric cancer have been limited, and the numbers of patients in most studies have been insufficient for any conclusion to be drawn [8–10]. Therefore, we conducted this study to evaluate the impact of high BMI on the surgical outcomes of LAG for patients with gastric cancer.