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Postsurgical complications associated with overweight in gastric cancer patients
Overweight patients with gastric cancer experienced more complications than nonoverweight patients following corrective resection but they had similar survival rates in a recent study.
Researchers evaluated 1,853 patients who underwent curative resection for gastric carcinoma between 1985 and 2007. They compared procedure outcomes between overweight (n=1,125) and nonoverweight patients (n=728), along with incidence of complications in a subset of 830 patients between January 2000 and December 2007. Overweight was defined as having a BMI of 25 kg/m2 or greater.
Overweight patients had a longer median operative time than nonoverweight patients (270 minutes vs. 240 minutes, P<.001), but nonoverweight patients had a larger median number of nodes removed (23 compared with 19, P<.001). Nonoverweight patients were more likely to have undergone adequate lymph node evaluation, defined as 15 examined nodes per patient (79.2% of patients compared with 73.3%, P=.047).
Postoperative death occurred in 1.8% of nonoverweight patients and 2.2% of overweight patients (P=.62). Investigators observed no significant differences in overall survival (49.9% among nonoverweight patients compared with 44.9% in overweight patients, P=.06) or disease-specific survival (56.6 for nonoverweight and 53.7% for overweight patients, P=.27) at 5 years.
Overweight patients experienced more postoperative complications than nonoverweight patients (47.9% of patients compared with 35.8%, P<.001), with an increased number of wound infections (8.9% compared with 4.7%, P=.02) and anastomotic leaks (11.8% compared with 5.4%, P=.002) in particular.
Multivariate analysis indicated associations between higher BMI and increased risk for anastomotic leak (OR=2.8, 1.57-5.1) and wound infection (OR=2.3, 1.25-4.39). Anastomotic leak also was associated with having undergone total gastrectomy (OR=1.9, 1.12-3.23), and both conditions were associated with having received neoadjuvant chemotherapy (OR=3.2, 1.99-5.24 for leaks and OR=2.3, 1.31-3.91 for infections) (95% CI for all).
“There is no difference in gastric cancer survival between overweight patients and thin patients,” the researchers concluded. “Increased abdominal fat is associated with inadequate staging in overweight patients, but this does not translate into a survival difference. Even after stratification by multivariate analysis, these patients are more prone to postoperative complications. These are important factors for surgeons and patients alike to be aware of to help plan effective treatment and intervention for patients undergoing gastric cancer operations.”