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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2013

01-11-2013

Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer

Authors: Motokazu Sugimoto, Takahiro Kinoshita, Hidehito Shibasaki, Yuichiro Kato, Naoto Gotohda, Shinichiro Takahashi, Masaru Konishi

Published in: Surgical Endoscopy | Issue 11/2013

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Abstract

Background

Laparoscopic distal gastrectomy for gastric cancer has been firmly established in recent decades but still is a difficult procedure, especially for obese patients, as with open surgery. This study aimed to evaluate the perioperative outcome of total laparoscopic distal gastrectomy (TLDG) for early gastric cancer patients with a body mass index (BMI) exceeding 25 kg/m2 and to consider countermeasures to this.

Methods

Perioperative outcomes were compared between 42 patients with a BMI exceeding 25 kg/m2 [overweight or obese group (OWG)] and 174 patients with a BMI lower than 25 kg/m2 [normal or underweight group (NWG)] who underwent TLDG between September 2010 and December 2012.

Results

The BMI was 26.0 ± 1.4 kg/m2 in the OWG group and 22.0 ± 2.1 kg/m2 in the NWG group (P < 0.001). The groups did not differ in terms of age, sex, American Society of Anesthesiologists score, presence of diabetes, number of retrieved lymph nodes, number of metastatic lymph nodes, or metastatic lymph node ratio. The two groups did not differ significantly with respect to the extent of lymph node dissection [OWG: D1 (11.9 %), D1+ (66.7 %), D2 (21.4 %) vs NWG: D1 (5.2 %), D1+ (51.7 %), D2 (43.1 %); P = 0.020] or tumor size (OWG: 25.5 ± 20.2 mm vs NWG: 33.0 ± 17.2 mm; P = 0.037). Differences in operation time (OWG: 212 ± 31 min vs NWG: 200 ± 35 min; P = 0.005) and estimated blood loss (OWG: 15 ± 22 ml vs NWG: 10 ± 34 ml; P = 0.013) seemed to have a minimal impact clinically. Postoperative complications including infectious complications and recovery after surgery did not differ between the two groups.

Conclusions

For overweight and obese patients, TLDG was managed safely. The procedure was considered to be difficult but sufficiently feasible.
Literature
1.
Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255:446–456PubMedCrossRef
2.
Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality-of-life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727PubMedCrossRef
3.
4.
WHO Expert Consultation (2004) Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163CrossRef
5.
Kinoshita T, Shibasaki H, Oshiro T, Ooshiro M, Okazumi S, Katoh R (2011) Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes. Surg Endosc 25:1395–1401PubMedCrossRef
6.
Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg 238:680–685PubMedCrossRef
7.
Kim KH, Kim MC, Jung GJ, Kim HH (2006) The impact of obesity on LADG for early gastric cancer. Gastric Cancer 9:303–307PubMedCrossRef
8.
Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, Yamamoto N, Nagano Y, Fujii S, Ono HA, Akiyama H, Shimada H (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093PubMedCrossRef
9.
Lee HJ, Kim HH, Kim MC, Ryu SY, Kim W, Song KY, Cho GS, Han SU, Hyung WJ, Ryu SW, Korean Laparoscopic Gastrointestinal Surgery Study Group (2009) The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer. Surg Endosc 23:2473–2479PubMedCrossRef
10.
Hiki N, Fukunaga T, Yamaguchi T, Ogura T, Miyata S, Tokunaga M, Ohyama S, Sano T (2009) Increased fat content and body shape have little effect on the accuracy of lymph node retrieval and blood loss in laparoscopic distal gastrectomy for gastric cancer. J Gastrointest Surg 13:626–633PubMedCrossRef
11.
Shim JH, Song KY, Kim SN, Park CH (2009) Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 39:481–486PubMedCrossRef
12.
Kim MG, Yook JH, Kim KC, Kim TH, Kim HS, Kim BS, Kim BS (2011) Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer. Surg Laparosc Endosc Percutan Tech 21:151–154PubMedCrossRef
13.
Kim MG, Kim KC, Kim BS, Kim TH, Kim HS, Yook JH, Kim BS (2011) A totally laparoscopic distal gastrectomy can be an effective way of performing laparoscopic gastrectomy in obese patients (body mass index ≥30). World J Surg 35:1327–1332PubMedCrossRef
14.
Oki E, Sakaguchi Y, Ohgaki K, Saeki H, Chinen Y, Minami K, Sakamoto Y, Toh Y, Kusumoto T, Okamura T, Maehara Y (2012) The impact of obesity on the use of a totally laparoscopic distal gastrectomy in patients with gastric cancer. J Gastric Cancer 12:108–112PubMedCrossRef
15.
Japanese Gastric Cancer Association (eds) (2010) Japanese classification of gastric carcinoma (Japanese), 14th edn. Kanehara, Tokyo
16.
Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours (UICC International Union Against Cancer), 7th edn. Wiley-Blackwell
17.
Japanese Gastric Cancer Association (eds) (2010) Gastric Cancer Treatment Guidelines 2010 (Japanese). Kanehara, Tokyo
18.
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287PubMedCrossRef
19.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef
20.
Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K (2002) Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 9:775–784PubMedCrossRef
21.
Saito H, Fukumoto Y, Osaki T, Yamada Y, Fukuda K, Tatebe S, Tsujitani S, Ikeguchi M (2008) Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer. J Surg Oncol 97:132–135PubMedCrossRef
22.
23.
Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, Kurita A, Katai H, Shimizu T, Furukawa H, Inoue S, Hiratsuka M, Kinoshita T, Arai K, Yamamura Y, Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group (2006) Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG 9501). Ann Surg Oncol 14:355–361PubMedCrossRef
24.
Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K (2000) Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer 3:141–144PubMedCrossRef
25.
Nobuoka D, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T (2011) Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today 41:928–934PubMedCrossRef
26.
Yamada H, Kojima K, Inokuchi M, Kawano T, Sugihara K (2008) Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy: comparison with open distal gastrectomy. J Gastrointest Surg 12:997–1004PubMedCrossRef
27.
Ojima T, Iwahashi M, Nakamori M, Nakamura M, Takifuji K, Katsuda M, Iida T, Tsuji T, Hayata K, Yamaue H (2012) The impact of abdominal shape index of patients on laparoscopy-assisted distal gastrectomy for early gastric cancer. Langenbecks Arch Surg 397:437–445PubMedCrossRef
28.
Huscher CG, Mingoli A, Sgarzini G, Brachini G, Binda B, Di Paola M, Ponzano C (2007) Totally laparoscopic total and subtotal gastrectomy with extended lymph node dissection for early and advanced gastric cancer: early and long-term results of a 100-patient series. Am J Surg 194:839–844PubMedCrossRef
29.
Guzman EA, Pigazzi A, Lee B, Soriano PA, Nelson RA, Benjamin Paz I, Trisal V, Kim J, Ellenhorn JD (2009) Totally laparoscopic gastric resection with extended lymphadenectomy for gastric adenocarcinoma. Ann Surg Oncol 16:2218–2223PubMedCrossRef
30.
Ikeda O, Sakaguchi Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Toh Y, Okamura T, Baba H (2009) Advantages of totally laparoscopic distal gastrectomy over laparoscopically assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2374–2379PubMedCrossRef
31.
Bracale U, Rovani M, Bracale M, Pignata G, Corcione F, Pecchia L (2012) Totally laparoscopic gastrectomy for gastric cancer: meta-analysis of short-term outcomes. Minim Invasive Ther Allied Technol 21:150–160PubMedCrossRef
32.
Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, Kohno H, Nagasue N (2000) Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 59:18–23PubMedCrossRef
Metadata
Title
Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer
Authors
Motokazu Sugimoto
Takahiro Kinoshita
Hidehito Shibasaki
Yuichiro Kato
Naoto Gotohda
Shinichiro Takahashi
Masaru Konishi
Publication date
01-11-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3045-x

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