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.
Similar content being viewed by others
References
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 255:446–456
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 248:721–727
World Health Organization Media Centre Obesity and Overweight Fact Sheet No. 311, May 2012. http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed 19 June 2013
WHO Expert Consultation (2004) Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163
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 25:1395–1401
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 238:680–685
Kim KH, Kim MC, Jung GJ, Kim HH (2006) The impact of obesity on LADG for early gastric cancer. Gastric Cancer 9:303–307
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 23:2085–2093
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 23:2473–2479
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 13:626–633
Shim JH, Song KY, Kim SN, Park CH (2009) Laparoscopy-assisted distal gastrectomy for overweight patients in the Asian population. Surg Today 39:481–486
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 21:151–154
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 35:1327–1332
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 12:108–112
Japanese Gastric Cancer Association (eds) (2010) Japanese classification of gastric carcinoma (Japanese), 14th edn. Kanehara, Tokyo
Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours (UICC International Union Against Cancer), 7th edn. Wiley-Blackwell
Japanese Gastric Cancer Association (eds) (2010) Gastric Cancer Treatment Guidelines 2010 (Japanese). Kanehara, Tokyo
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 195:284–287
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 138:8–13
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 9:775–784
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 97:132–135
Zhou Y, Zhang J, Cao S, Li Y (2012). The evaluation of metastatic lymph node ratio staging system in gastric cancer. Gastric Cancer. doi:10.1007/s10120-012-0190-1
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 14:355–361
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 3:141–144
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 41:928–934
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 12:997–1004
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 397:437–445
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 194:839–844
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 16:2218–2223
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 23:2374–2379
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 21:150–160
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 59:18–23
Disclosures
Motokazu Sugimoto, Takahiro Kinoshita, Hidehito Shibasaki, Yuichiro Kato, Naoto Gotohda, Shinichiro Takahashi, and Masaru Konishi have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sugimoto, M., Kinoshita, T., Shibasaki, H. et al. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc 27, 4291–4296 (2013). https://doi.org/10.1007/s00464-013-3045-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3045-x