Effect of Body Mass Index in Patients Undergoing Resection for Gastric Cancer: A Single Center US Experience

Abstract

IntroductionWith rising obesity in the USA, the impact of body mass index (BMI) on survival in gastric cancer remains unclear. MethodsAn institutional database of patients undergoing surgical evaluation for gastric cancer was reviewed. Patients were stratified by the following BMI: <18.5, 18.5–25, 25.1–30, and >30. Clinicopathologic factors and overall survival (OS) were analyzed. ResultsFrom 1997 to 2012, 222 patients underwent exploration for gastric adenocarcinoma. 186 (84 %) had BMI recorded: nine (5 %) <18.5, 72 (39 %) 18.5–25, 62 (33 %) 25.1–30, and 43 (23 %) >30. One hundred thirty-five (73 %) ultimately underwent resection. Although American Society of Anesthesiology score and blood loss were not associated with increasing BMI, operative time was longer, p = 0.02. Proximal location, perineural invasion, lymphovascular invasion, positive surgical margins, and positive lymph nodes (LN+) were all associated with worse OS but not with increased BMI. Although increased BMI was associated with a lower lymph node count, p = 0.004, the number of LN + and final pathologic stage were not associated with BMI. Additionally, use of neoadjuvant or adjuvant chemotherapy was not associated with BMI. Median OS was 22 months. Median OS was improved with increased BMI: 21 months for <18.5, 13 months 18.5–25, 28 months 25–30, and 34 months >30, p = 0.02. Disease-free survival (DFS) was similar: 2 months for <18.5, 7 months 18.5–25, 15 months 25.1–30, and 15 months >30, p = 0.02. ConclusionAlthough BMI may impact the technical difficulty of resection for gastric cancer, increasing BMI is not associated with more advanced disease. In this experience, increased BMI does not adversely impact OS or DFS.