Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2009

01-06-2009 | Gastrointestinal Oncology

Accumulation of Excess Visceral Fat Is a Risk Factor for Pancreatic Fistula Formation After Total Gastrectomy

Authors: Koji Tanaka, MD, Isao Miyashiro, MD, Masahiko Yano, MD, Kentaro Kishi, MD, Masaaki Motoori, MD, Yousuke Seki, MD, Shingo Noura, MD, Masayuki Ohue, MD, Terumasa Yamada, MD, Hiroaki Ohigashi, MD, Osamu Ishikawa, MD

Published in: Annals of Surgical Oncology | Issue 6/2009

Login to get access

Abstract

Background

The effect of obesity on gastrectomy in patients with gastric cancer is controversial. The degree of abdominal fat increases the technical difficulty of abdominal surgery. This study examined the effect of visceral fat on total gastrectomy and risk factors associated with the formation of pancreatic fistula.

Methods

Between February 2001 and April 2007, 191 patients with gastric cancer underwent total gastrectomy. The visceral fat area (VFA) was calculated from computed tomography (CT) scans taken at the level of the umbilicus using FatScan Software. Patients were divided into high- (≥100 cm2, n = 52) and low-VFA groups (<100 cm2, n = 139), and also into high- (≥25 kg/m2, n = 47) and low-BMI groups (<25 kg/m2, n = 144).

Results

Blood loss and incidence of pancreatic fistula were significantly higher in the high- than low-VFA group. However, only blood loss was significantly different between the high- and low-BMI groups. VFA, blood loss, and splenectomy were identified as significant risk factors for pancreatic fistula formation on univariate analysis, and multivariate logistic regression analysis of these factors identified VFA (p = 0.0001) and splenectomy (p = 0.0014) as significant predictors of pancreatic fistula.

Conclusions

VFA is a better indicator for pancreatic fistula formation after total gastrectomy than is BMI. Lymph node dissection must be performed carefully, especially in patients with visceral fat accumulation during total gastrectomy with splenectomy.
Literature
1.
Noshiro H, Shimizu S, Nagai E, et al. Laparoscopy-assisted distal gastrectomy for early gastric cancer: is it beneficial for patients of heavier weight? Ann Surg. 2003;238:680–5.PubMedCrossRef
2.
Bouchard C, Despres JP, Mauriege P. Genetic and nongenetic determinants of regional fat distribution. Endocr Rev. 1993;14:72–93.PubMed
3.
Gretschel S, Christoph F, Bembenek A, et al. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol. 2003;10:363–8.PubMedCrossRef
4.
Lee JH, Paik YH, Lee JS, et al. Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol. 2007;14:1288–94.PubMedCrossRef
5.
Tsujinaka T, Sasako M, Yamamoto S, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14:355–61.PubMedCrossRef
6.
Matsuzawa Y, Inoue S, Ikeda Y, Sakata T, et al. New criteria for ‘obesity disease’ in Japan. Circ J 2002;66:987–92.
7.
Kadowaki T, Sekikawa A, Murata K, et al. Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes (Lond). 2006;30:1163–65.CrossRef
8.
Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987;36:54–9.PubMedCrossRef
9.
Fujimoto WY, Newell-Morris LL, Grote M, et al. Visceral fat obesity and morbidity: NIDDM and atherogenic risk in Japanese American men and women. Int J Obes. 1991;15 Suppl 2:41–4.PubMed
10.
Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S. A novel technique for the determination of body fat by computed tomography. Int J Obes. 1983;7:437–45.PubMed
11.
Kvist H, Chowdhury B, Sjostrom L, et al. Adipose tissue volume determination in males by computed tomography and 40 K. Int J Obes. 1988;12:249–66.PubMed
12.
Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology. 1999;211:283–86.PubMed
13.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.
14.
Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef
15.
Maurovich-Horvat P, Massaro J, Fox CS, et al. Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. Int J Obes (Lond). 2007;31:500–6.CrossRef
16.
Makino H, Kunisaki C, Akiyama H, et al. Effect of obesity on intraoperative bleeding volume in open gastrectomy with D2 lymph-node dissection for gastric cancer. Patient Saf Surg. 2008;2:7.PubMedCrossRef
17.
Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.PubMedCrossRef
18.
Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia. J Gastrointest Surg. 2007;11:1039–44.PubMedCrossRef
19.
House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12:270–8.PubMedCrossRef
20.
Seki Y, Ohue M, Sekimoto M, et al. Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc. 2007;21:929–34.PubMedCrossRef
21.
Tsujinaka S, Konishi F, Kawamura YJ, et al. Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum. 2008;51:1757–67.PubMedCrossRef
22.
Buntrock P, Jentzsch KD, Heder G. Stimulation of wound healing, using brain extract with fibroblast growth factor (FGF) activity. I. Quantitative and biochemical studies into formation of granulation tissue. Exp Pathol. 1982;21:46–53.PubMed
23.
Rabinovsky ED, Draghia-Akli R. Insulin-like growth factor I plasmid therapy promotes in vivo angiogenesis. Mol Ther. 2004;9:46–55.PubMedCrossRef
24.
Seida A, Wada J, Kunitomi M, et al. Serum bFGF levels are reduced in Japanese overweight men and restored by a 6-month exercise education. Int J Obes Relat Metab Disord. 2003;27:1325–31.PubMedCrossRef
25.
Kabon B, Nagele A, Reddy D, et al. Obesity decreases perioperative tissue oxygenation. Anesthesiology. 2004;100:274–80.PubMedCrossRef
Metadata
Title
Accumulation of Excess Visceral Fat Is a Risk Factor for Pancreatic Fistula Formation After Total Gastrectomy
Authors
Koji Tanaka, MD
Isao Miyashiro, MD
Masahiko Yano, MD
Kentaro Kishi, MD
Masaaki Motoori, MD
Yousuke Seki, MD
Shingo Noura, MD
Masayuki Ohue, MD
Terumasa Yamada, MD
Hiroaki Ohigashi, MD
Osamu Ishikawa, MD
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0391-y

Other articles of this Issue 6/2009

Annals of Surgical Oncology 6/2009 Go to the issue

Melanomas

Age-Related Lymphatic Dysfunction in Melanoma Patients

Hepatobiliary and Pancreatic Tumors

Recurrence Patterns After Hepatectomy of Hepatocellular Carcinoma: Implication of Milan Criteria Utilization

Gastrointestinal Oncology

Reply: High Sensitivity of Indocyanine Green Fluorescence Imaging in Detection of Sentinel Node

Bone and Soft Tissue Sarcomas

Desmoids: A Revelation in Biology and Treatment

Gastrointestinal Oncology

Emerging Role of Laparoscopic and Robotic Surgery for Rectal Cancers

Breast Oncology

Diagnostic Breast Magnetic Resonance Imaging and Contralateral Prophylactic Mastectomy