We tried to determine the role of the body mass index (BMI) on the extent of lymph node dissection in gastric cancer surgery. Seven hundred and eighty-seven patients with gastric carcinoma were reviewed. Ninety-two (11%) patients exceeded the upper limit of the optimum BMI. Significantly fewer lymph nodes were removed following D2 (p = 0.002) and ≥D3 (p = 0.023) dissections, and the lymph node ratio was significantly (p = 0.0383) higher in overweight patients. The recurrence-free survival was significantly (p = 0.0297) shorter in T2/T3 cases with high BMI, and BMI (relative risk 1.85) became an independent prognostic factor in multivariate analysis. Higher BMI hampers regional lymph node dissection in gastric cancer patients and became an independent predictor of disease recurrences in T2/T3 gastric cancers.

1.
Keller E, Stutzer H, Heitmann K, Bauer P, Gebbensleben B, Rodhe H, and the German Stomach Cancer TNM Study Group: Lymph node staging in 872 patients with carcinoma of the stomach and presumed benefit of lymphadenectomy. J Am Coll Surg 1994;178:38–46.
2.
Shiu MH, Moore E, Sanders M, Huvos A, Freedman B, Goodbold J: Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis. Arch Surg 1987;122:1347–1351.
3.
Roukos DH, Lorenz M, Encke A: Evidence of survival benefit of extended (D2) lymphadenectomy in western patients with gastric cancer based on a new concept: A prospective long-term follow-up study. Surgery 1998;123:573–578.
4.
Siewert JR, Bottcher K, Stein HJ, Roder JD: Relevant prognostic factors in gastric cancer: Ten-year results of the German Gastric Cancer Study. Ann Surg 1998;228:449–461.
5.
Noguchi M, Miyazaki I: Prognostic significance and surgical management of lymph node metastasis in gastric cancer. Br J Surg 1996;83:156–161.
6.
Bonenkamp JJ, van de Velde CJH, Kampschoer GHM, Hermans J, Hermanek P, Bemelmans M: Comparison of factors influencing the prognosis of Japanese, German and Dutch gastric cancer patients. World J Surg 1993;17:410–416.
7.
Roder JD, Bonenkamp JJ, Craven J, van de Velde CJH, Sasako M, Bottcher K, Stein HJ: Lymphadenectomy for gastric cancer in clinical trials: Update. World J Surg 1995;19:546–553.
8.
Bonenkamp JJ, van de Velde CJH, Sasako M, Hermans J: R2 compared with R1 resection for gastric cancer: Morbidity and mortality in a prospective, randomized trial. Eur J Surg 1992;158:413.
9.
Nomura A, Heilbrun LK, Stemmermann GN: Body mass index as a predictor of cancer in men. J Natl Cancer Inst 1985;74:319–323.
10.
Boyd NF, Campbell JE, Germanson T, Thomson DB, Sutherland DJ, Meakin JW: Body weight and prognosis in breast cancer. J Natl Cancer Inst 1981;67:785–789.
11.
Hansson LE, Baron J, Nyren O, Bergstrom R, Wolk A, Lindgren A, Adami HO: Early-life risk indicators of gastric cancer. A population-based case-control study in Sweden. Int J Cancer 1994;57:32–37.
12.
NIH Consensus Development Conference: Statement II. Health implications of obesity. Ann Intern Med 1985;103:1073–1077.
13.
Yanai M, Kon A, Kumasaka K, Kawano K: Body mass index variations by age and sex, and prevalence of overweight in Japanese adults. Intl J Obes Relat Metab Disord 1997;21:484–488.
14.
Japanese Rearch Society for Gastric Cancer: The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 1981;11:127–139.
15.
Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ, and the German Gastric Cancer Study Group: Prognostic relevance of systemic lymph node dissection in gastric carcinoma. Br J Surg 1993;80:1015–1018.
16.
Wagner PK, Ramaswamy A, Ruschoff J, Schmitz MP, Rothmund M: Lymph node counts in the upper abdomen: Anatomical basis for lymphadenectomy in gastric cancer. Br J Surg 1991;78:825–827.
17.
Rodger JD, Bottcher K, Siewert JR, Busch R, Hermanek P, Meyer HJ, and the German Gastric Cancer Study Group: Prognostic factors in gastric carcinoma: Results of the German Gastric Carcinoma Study 1992. Cancer 1993;72:2089–2097.
18.
Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Adachi Y: Pathology and prognosis of gastric carcinoma: Findings in 10000 patients who underwent primary gastrectomy. Cancer 1992;70:1030–1034.
19.
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJH: Extended lymph node dissection for gastric cancer. Dutch Gastric Cancer Group. N Engl J Med 1999;340:980–1014.
20.
Dent DM, Madden MV, Price SK: Randomized comparison of R1 and R2 gastrectomy for gastric cancer. Br J Surg 1988;75:110–116.
21.
Baba S, Pan WH, Ueshima H, Ozawa H, Komachi Y, Stamler R: Blood pressure levels, related factors, and hypertension control status of Japanese and Americans. J Hum Hypertens 1991;5:317–332.
22.
Seidell JC, Flegal KM: Assessing obesity: Classification and epidemiology. Br Med Bull 1997;53:238–252.
23.
Williamson DF: Descriptive epidemiology of body weight and weight change in U.S. adults. Ann Intern Med 1993;119:646–649.
24.
Pasulka PS, Bristrain BR, Benotti PN: The risks of surgery in obese patients. Ann Intern Med 1986;104:540–546.
25.
Brooks-Brunn JA: Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997;111:564–571.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.