Excessive visceral fat area as a risk factor for early postoperative complications of total gastrectomy for gastric cancer: a retrospective cohort study.

Masashi Takeuchi,Hiroaki Seki,Nobutaka Yasui,Hidetoshi Matsumoto,Michio Sakata,Kenjiro Ishii,Akihiko Shimada

doi:10.1186/s12893-016-0168-8

Abstract

BackgroundObesity is a known risk factor for complications after digestive surgery. Body mass index (BMI) is commonly used as an index of obesity but does not always reflect the degree of obesity. Although some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. In this study, we demonstrated that VFA is more useful than BMI in predicting complications after total gastrectomy.MethodsSeventy-five patients who underwent total gastrectomy for gastric cancer were enrolled in this study; they were divided into two groups: a high-VFA group (n = 26, ≥100 cm2) and a low-VFA group (n = 49, <100 cm2). We retrospectively evaluated the preoperative characteristics and surgical outcomes of all patients and examined postoperative complications within 30 days of surgery (including cardiac complications, pneumonia, ileus, anastomotic leakage, pancreatic fistula, incisional surgical site infection [SSI], abdominal abscess, and hemorrhage).ResultsThe incidence of anastomotic leakage (p = 0.03) and incisional SSI (p = 0.001) were higher in the high-VFA group than in the low-VFA group. No significant differences were observed in the other factors. We used univariate analysis to identify risk factors for anastomotic leakage and incisional SSI. Age and VFA were risk factors for anastomotic leakage, and BMI and VFA were risk factors for incisional SSI. A multivariate analysis including these factors found that only VFA was a predictor of anastomotic leakage (hazard ratio [HR] 4.62; 95 % confidence interval [CI] 1.02–21.02; p = 0.048) and incisional SSI (HR 4.32; 95 % CI 1.18–15.80; p = 0.027].ConclusionsHigh VFA is more useful than BMI in predicting anastomotic leakage and SSI after total gastrectomy. Therefore, we should consider the VFA value during surgery

Highlights

Obesity is a known risk factor for complications after digestive surgery
We demonstrated that visceral fat area (VFA) is more useful than Body mass index (BMI) in predicting postoperative complications in total gastrectomy
The groups were similar in terms of mean age

Summary

Introduction

Obesity is a known risk factor for complications after digestive surgery. Some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. Total gastrectomy for gastric cancer is one of the highly invasive surgeries in gastroenterology, and is associated with high morbidity and mortality. A recent study reported a 30-day morbidity rate of 36 % and mortality rate of 4.7 % after total gastrectomy [1], with common postoperative complications being respiratory complications (16 %), sepsis (15 %), organ/space infection (9 %), Obesity is a known risk factor for postoperative complications in digestive surgery [2]. Recent studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery [6, 7]. There have been few studies on the relationship between VFA and total gastrectomy

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Conclusion