Influence of Body Mass Index on Postoperative Complications after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIXiao-tong , CHENYi-jiang , ZHAOSheng , LUOJin-hua , WANGWei ,  ZHOUYue

Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P. R. China;

Corresponding author：

ZHOUYue, Email: chirurgeonzhouyue@163.com

Keywords：

Body mass index; Overweight; Esophageal squamous cell carcinoma; Esophagectomy; Complications

DOI：

10.7507/1007-4848.20160244

Video：

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Objective To determine the influence of high BMI on postoperative complications in a cohort of squamous esophageal cancer patients. Methods We retrospectively analyzed the clinical data of 450 consecutive esophageal cancer patients who underwent esophagectomy in our hospital from September 2010 through November 2012 year. The patients were divided into three groups. Forty-five patients were classified as a low BMI group (BMI < 18.5 kg/m²), 304 patients were classified as a normal BMI group (18.5≤BMI < 25.0 kg/m²), and 101 patients as a high BMI group (BMI≥25.0 kg/m²). Patients' demographics, tumor characteristics, and postoperative complications were compared among the three groups. Results The comorbidity of diabetes was higher in the high BMI group compared with the other two groups (P=0.025). Longer operative time, wound infection or delayed healing were more frequent in the high BMI group (P=0.010 and P=0.039, respectively). Pneumonia and length of hospital stay had a tendency to increase in the high BMI group (P=0.052 and P=0.081, respectively). However, the differences did not reach statistical significance. There was no statistical difference in pulmonary embolism, respiratory failure, anastomotic leakage, vocal code paresis, chylothorax, other organ damage, reoperation, arrhythmia, or in-hospital mortality among the three groups. Conclusions High BMI has a negative impact on postoperative morbidity after esophagectomy. However, overweight is not a postoperative complications which should always be paid attention to.

Citation： QIXiao-tong, CHENYi-jiang, ZHAOSheng, LUOJin-hua, WANGWei, ZHOUYue. Influence of Body Mass Index on Postoperative Complications after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1034-1038. doi: 10.7507/1007-4848.20160244 Copy

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13.	Hayashi Y, Correa AM, Hofstetter WL, et al. The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy. Cancer, 2010, 116(24): 5619-5627.
14.	Yoon HH, Lewis MA, Shi Q, et al. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J Clin Oncol, 2011, 29(34): 4561-4567.
15.	Zhang SS, Yang H, Luo KJ, et al. The impact of body mass index on complication and survival in resected oesophageal cancer: A clinical-based cohort and meta-analysis. Br J Cancer, 2013, 109(11): 2894-2903.
16.	Watanabe M, Ishimoto T, Baba Y, et al. Prognostic impact of body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol, 2013, 20(12): 3984-3991.
17.	Miao L, Chen H, Xiang J, et al. A high body mass index in esopha-geal cancer patients is not associated with adverse outcomes follo-wing esophagectomy. J Cancer Res Clin Oncol, 2015, 141(5): 941-950.
18.	Blom RL, Lagarde SM, Klinkenbijl JH, et al. A high body mass index in esophageal cancer patients does not influence postoperative out-come or long-term survival. Ann Surg Oncol, 2012, 19(3): 766-771.
19.	Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: Incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
20.	Tanaka S, Inoue S, Isoda F, et al. Impaired immunity in obesity: Suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord, 1993, 17(11): 631-636.

1. Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth, 2000, 85(1): 91-108.
2. Ashrafian H, Athanasiou T, Le Roux CW. Heart remodelling and obesity: The complexities and variation of cardiac geometry. Heart, 2011, 97(3): 171-172.
3. Dindo D, Muller MK, Weber M, et al. Obesity in general elective surgery. Lancet, 2003, 361(9374): 2032-2035.
4. Ogden CL, Yanovski SZ, Carroll MD, et al. The epidemiology of obesity. Gastroenterology, 2007, 132(6): 2087-2102.
5. Mathur AK, Ghaferi AA, Osborne NH, et al. Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg, 2010, 14(8): 1285-1291.
6. Nobuoka D, Gotohda N, Kato Y, et al. Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today, 2011, 41(7): 928-934.
7. Yasunaga H, Horiguchi H, Matsuda S, et al. Body mass index and outcomes following gastrointestinal cancer surgery in japan. Br J Surg, 2013, 100(10): 1335-1343.
8. Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophage-ctomy using data of 5354 patients included in a japanese nationwide web-based database. Ann Surg, 2014, 260(2): 259-266.
9. Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer: A meta-analysis. Ann Thorac Surg, 2013, 96(6): 1933-1941.
10. Fujita H, Sueyoshi S, Tanaka T, et al. Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: Comparing the short-and long-term outcome among the four types of lymp-hadenectomy. World J Surg, 2003, 27(5): 571-579.
11. Obesity: Preventing and managing the global epidemic. Report of a who consultation. World Health Organization technical report series, 2000, 894: i-xii, 1-253.
12. Healy LA, Ryan AM, Gopinath B, et al. Impact of obesity on outco-mes in the management of localized adenocarcinoma of the esopha-gus and esophagogastric junction. J Thorac Cardiovasc Surg, 2007, 134(5): 1284-1291.
13. Hayashi Y, Correa AM, Hofstetter WL, et al. The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy. Cancer, 2010, 116(24): 5619-5627.
14. Yoon HH, Lewis MA, Shi Q, et al. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J Clin Oncol, 2011, 29(34): 4561-4567.
15. Zhang SS, Yang H, Luo KJ, et al. The impact of body mass index on complication and survival in resected oesophageal cancer: A clinical-based cohort and meta-analysis. Br J Cancer, 2013, 109(11): 2894-2903.
16. Watanabe M, Ishimoto T, Baba Y, et al. Prognostic impact of body mass index in patients with squamous cell carcinoma of the esophagus. Ann Surg Oncol, 2013, 20(12): 3984-3991.
17. Miao L, Chen H, Xiang J, et al. A high body mass index in esopha-geal cancer patients is not associated with adverse outcomes follo-wing esophagectomy. J Cancer Res Clin Oncol, 2015, 141(5): 941-950.
18. Blom RL, Lagarde SM, Klinkenbijl JH, et al. A high body mass index in esophageal cancer patients does not influence postoperative out-come or long-term survival. Ann Surg Oncol, 2012, 19(3): 766-771.
19. Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: Incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
20. Tanaka S, Inoue S, Isoda F, et al. Impaired immunity in obesity: Suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord, 1993, 17(11): 631-636.

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