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Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population

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Abstract

Purpose

It is generally considered difficult to operate on overweight patients, who are also at increased risk of postoperative complications. We conducted this study to clarify the technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) in overweight patients.

Methods

Between July 2004 and December 2006, 116 patients with preoperatively diagnosed EGC underwent LADG at our department. We classified these patients into two groups based on body mass index (BMI). There were 60 patients in the high-BMI (≥23 kg/m2) group and 56 in the low-BMI (<23 kg/m2) group. The clinicopathologic features, postoperative outcomes, and operationrelated morbidities were compared.

Results

None of the patients needed conversion to laparotomy. There were no notable differences in clinical characteristics or histologic features between the groups. Although the operation time was significantly longer in the high-BMI group, there were no significant differences in postoperative bowel recovery, postoperative hospital stay, or operation-related morbidities.

Conclusions

Laparoscopy-assisted distal gastrectomy for overweight patients is feasible and safe; however, because of its technical difficulties and the complexities of lymph node dissection, it should be carefully considered, and may only be suitable for early-stage cancers.

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References

  1. Jentschura D, Heubner C, Manegold BC, Rumstadt B, Winkler M, Trede M. Surgery for early gastric cancer: a European one-center experience. World J Surg 1997;21:845–848.

    Article  PubMed  CAS  Google Scholar 

  2. Yokota T, Ishiyama S, Saito T, Teshima S, Shimotsuma M, Yamauchi H. Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol 2003;4:423–428.

    Article  PubMed  Google Scholar 

  3. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36–41.

    PubMed  CAS  Google Scholar 

  4. Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F. Complete ten-year postgastrectomy follow up of early gastric cancer. Am J Surg 1989;158:14–16.

    Article  PubMed  CAS  Google Scholar 

  5. Endo M, Habu H. Clinical studies of early gastric cancer. Hepatogastroenterology 1990;37:408–410.

    PubMed  CAS  Google Scholar 

  6. Kitagawa Y, Kitano S, Kubota T, Kumai K, Otani Y, Saikawa Y, et al. Minimally invasive surgery for gastric cancer—toward a confluence of two major streams: a review. Gastric Cancer 2005;8:103–110.

    Article  PubMed  Google Scholar 

  7. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N;Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007;245:68–72.

    Article  PubMed  Google Scholar 

  8. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.

    PubMed  CAS  Google Scholar 

  9. Yasuda K, Shiraishi N, Etoh T, Shiromizu A, Inomata M, Kitano S. Long-term quality of life after laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 2007;21:2150–2153.

    Article  PubMed  CAS  Google Scholar 

  10. Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 2008;22:655–659.

    Article  PubMed  CAS  Google Scholar 

  11. Simopoulos C, Botaitis S, Karayiannakis AJ, Tripsianis G, Pitiakoudis M, Polychronidis A. The contribution of acute cholecystitis, obesity, and previous abdominal surgery on the outcome of laparoscopic cholecystectomy. Am Surg 2007;73:371–376.

    PubMed  Google Scholar 

  12. Kim KH, Kim MC, Jung GJ, Kim HH. The impact of obesity on LADG for early gastric cancer. Gastric Cancer 2006;9:303–307.

    Article  PubMed  Google Scholar 

  13. Yasuda K, Inomata M, Shiraishi N, Izumi K, Ishikawa K, Kitano S. Laparoscopy-assisted distal gastrectomy for early gastric cancer in obese and nonobese patients. Surg Endosc 2004;18:1253–1256.

    Article  PubMed  CAS  Google Scholar 

  14. Adachi W, Kobayashi M, Koike S, Rafique M, Nimura Y, Kuroda T, et al. The influence of excess body weight on the surgical treatment of patients with gastric cancer. Surg Today 1995;25:939–945.

    Article  PubMed  CAS  Google Scholar 

  15. Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 2005;19:1592–1596.

    Article  PubMed  CAS  Google Scholar 

  16. World Health Organization. Obesity, preventing and managing the global endemic. WHO Technical Report Series no. 894. Geneva: WHO; 2000.

    Google Scholar 

  17. Ota T, Takamura T, Hirai N, Kobayashi K. Preobesity in World Health Organization classification involves the metabolic syndrome in Japanese. Diabetes Care 2002;25:1252–1253.

    Article  PubMed  Google Scholar 

  18. Cho J, Juon HS. Assessing overweight and obesity risk among Korean Americans in California using World Health Organization body mass index criteria for Asians. Prev Chronic Dis 2006;3:A79.

    PubMed  Google Scholar 

  19. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157–163.

    Article  Google Scholar 

  20. Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymph-adenectomy (JCOG9501). Ann Surg Oncol 2007;14:355–361.

    Article  PubMed  Google Scholar 

  21. Cho BC, Jeung HC, Choi HJ, Rha SY, Hyung WJ, Cheong JH, et al. Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute. J Surg Oncol 2007;95:461–468.

    Article  PubMed  Google Scholar 

  22. Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, et al. Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 2000;59:18–23.

    Article  PubMed  CAS  Google Scholar 

  23. Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol 2003;10:363–368.

    Article  PubMed  Google Scholar 

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Shim, J.H., Song, K.Y., Kim, S.N. et al. Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 39, 481–486 (2009). https://doi.org/10.1007/s00595-008-3829-0

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  • DOI: https://doi.org/10.1007/s00595-008-3829-0

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