Impact of obesity on short- and long-term outcomes of laparoscopy assisted distal gastrectomy for gastric cancer.

Abstract

Laparoscopy assisted distal gastrectomy (LADG) for gastric cancer has been rapidly adopted for the treatment of both early and advanced gastric cancers which need lymph node dissection, but remains difficult procedure, especially in patients with obesity. We evaluated the impact of obesity on short- and long-term outcomes of LADG for gastric cancer. We retrospectively investigated 243 patients who underwent LADG for gastric cancer between January 2007 and December 2014. The patients were classified based on their body mass index (BMI) into the Obese (BMI≥25) and Non-Obese (BMI<25) Groups. Patient characteristics, clinicopathologic and operative findings, and short- and long-term outcomes were investigated and compared between the groups. The groups did not differ in age, sex, American Society of Anesthesiologists score, the presence of comorbidities, or pathologic stage. Operative time (265±46.6 vs. 244±55.6min; P=0.007) and estimated blood loss (113±101.4 vs. 66.5±95.2ml; P=0.007) were greater in the Obese Group. Fewer lymph nodes were retrieved in the Obese Group (38±23.7 vs. 47.5±24.3; P=0.004). No differences were evident in postoperative complication rate (20% vs. 17%; P=0.688) or the duration of postoperative hospital stay (9±8.5 vs. 9±5.1days; P=0.283) between the two groups. In the Obese Group, the 5-year overall survival rate was significantly lower than in the Non-Obese Group (67.6% vs. 90.3%; P=0.036). Furthermore, 5-year disease-specific survival was significantly lower in the Obese Group than in the Non-Obese Group (72.7% vs. 94.9%; P=0.015). LADG in patients with obesity could be performed as safe as in patients without obesity, with comparable postoperative results. But obesity may be a poor prognostic factor in gastric cancer.