Laparoscopic Gastrectomy Versus Open Gastrectomy for Gastric Cancer in Patients with Body Mass Index of 30 kg/m2 or more.

Do Joong Park, MD, PhD, Sang-Yong Son, MD, Chang Min Lee, MD, Do-Hyun Jung, MD, Sang-Hoon Ahn, MD, Hyung-Ho Kim, MD, PhD. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Background: High body mass index (BMI) and high visceral fat area (VFA) are known to be a preoperative risk factor for laparoscopic gastrectomy (LG) for gastric cancer. However, the impact of obesity on LG still remains controversial. In the present study, we compared the operative outcomes of LG with those of OG in patients with BMI of ≥ 30 kg/m2.
Methods: Seventy-seven patients who underwent distal or total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups by approach method; an OG group (n=19) and a LG group (n=58). Aquarius iNtuition® program was used to measure VFA. The operation time, estimated blood loss, complication rate, the number of retrieved lymph nodes, and patient survival were compared between two groups.
Results: The mean BMI and VFA were 31.6 kg/m2 and 194.8 cm2. The complication rate was 42.1% in OG group and 15.5% in LG group, respectively (p=0.015). LG group showed less estimated blood loss (p=0.031) and fast recovery of bowel movement (p<0.001). However, there were no significant differences in operation time, the number of retrieved lymph nodes, and the length of hospital stay between two groups. In subgroup analysis, there was significant correlation between estimated blood loss and VFA (R2=0.124, p=0.012), but there was no correlation between operation time and VFA (R2=0.011, p=0.474). The 5-year survival was not different between two groups (p=0.186)
Conclusion: LG showed better operative outcomes compared with OG, in terms of less estimated blood loss, fast recovery of bowel movement, and low complication rate, in patients with BMI of ≥ 30 kg/m2.

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