Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review

Objective Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after oesophagectomy for adenocarcinoma of the oesophagus. Design Retrospective database review. Setting Single institution high volume oncological tertiary care referral centre. Participants From our comprehensive oesophageal cancer database consisting of 709 patients, we stratified patients according to BMI: 155 normal-weight (BMI 20–24), 198 overweight (BMI 25–29) and 187 obese (BMI ≥30) patients. Interventions All patients underwent oesophagectomy for cancer. Primary and secondary outcome measures Incidences of preoperative risk factors and perioperative complications in each group were analysed. Results The patient cohort consisted of 474 men and 66 women with a mean age of 64.3 years (28–86). They were similar in terms of demographics and comorbidities, with the exception of a younger age (65.2 vs 65.4 vs 62.5 years, p=0.0094), and a higher incidence of diabetes (9.1% vs 13.2% vs 22.7%, p=0.001), hiatal hernia (16.8% vs 17.8% vs 28.8%, p=0.009) and Barrett oesophagus (24.7% vs 25.4% vs 36.2%, p=0.025) for obese patients. The type of surgery performed, overall blood loss, extent of lymphadenectomy, R0 resections and complications were not influenced by BMI on univariate and multivariate analysis. Conclusions In our experience, patients with an elevated BMI and oesophageal adenocarcinoma do not experience an increase in morbidity and mortality after oesophagectomy as stated in previous reports, when performed at a high volume centre. Additionally, BMI did not affect the quality of oncological resection as determined by number of harvested lymph-nodes and rates of R0 resections. Trial Registration MCC 15030, IRB 105286.

• Publication year

  2013

• Venue

  BMJ Open

• Publication date

  2013-05-02

• Fields of study

  Medicine

• Identifiers
  DOI 10.1136/bmjopen-2012-001336PMID 23645908PMCID 3646172
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• Obese patients were younger and had higher rates of diabetes, hiatal hernia, and Barrett oesophagus than the lower-BMI groups.

  Confidence 0.89

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• Body mass index did not influence operative factors or oncologic resection quality, including blood loss, extent of lymphadenectomy, and R0 resection rates.

  Confidence 0.93

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• Elevated body mass index was not associated with higher perioperative complication rates after oesophagectomy for oesophageal adenocarcinoma in the high-volume tertiary setting examined.

  Confidence 0.96

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review

• body mass index (bmi)

  exposure, covariate

  A height-and-weight based measure used here to stratify patients into normal-weight, overweight, and obese groups.

  Aliases: BMI

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• high-volume centre

  setting, institution

  A tertiary referral hospital performing a large number of oesophageal cancer operations, used as the study setting.

  Aliases: high volume centre, high-volume tertiary care centre

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• lymphadenectomy

  procedure, surgical measure

  Surgical removal of lymph nodes performed during oesophagectomy and evaluated as part of oncologic quality.

  Aliases: lymph node dissection

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• oesophageal adenocarcinoma

  disease, cancer type

  The esophageal cancer histology of the patients included in the database review.

  Aliases: esophageal adenocarcinoma

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• oesophagectomy

  procedure, surgical intervention

  Surgical removal of the esophagus performed as cancer treatment in the included patients.

  Aliases: esophagectomy

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• perioperative complications

  outcome, clinical event

  Adverse clinical events occurring before, during, or soon after surgery and used as an outcome in the analysis.

  Aliases: complications

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review
• r0 resection

  outcome, surgical measure

  A surgical resection with no microscopic residual tumor at the margins, used as an oncologic outcome measure.

  Aliases: complete resection

  박진우 (dztg5apj7m) extractionB (s683577b42) reviewKiller Whale (322360f1c1) reviewAK (4715169a40) review

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