Body Mass Index and Perioperative Complications After Esophagectomy for Cancer

Marcovalerio Melis, Kenneth L. Meredith, Jill Weber, Erin M. Siegel, James Mcloughlin, E. M. Dean, Nilay Shah, Richard C. Karl

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND:: Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after esophagectomy for cancer. METHODS:: From our comprehensive esophageal cancer database consisting of 510 patients, we identified 166 obese (BMI ≥30), 176 overweight (BMI 25–29), and 148 normal-weight (BMI 20–24) patients. Malnourished patients (BMI of <20) were excluded. Incidence of preoperative risk factors and perioperative complications in each group were analyzed. RESULTS:: The patient group consists of 420 men and 70 women with a mean age at time of surgery were 64 years (range 28–86 years). The categories of patients (obese, overweight, and normal-weight) were similar in terms of demographics and comorbidities, with the exception of a younger age (62.5 years vs 66.2 years vs 65.3 years, P?=?0.002), and a higher incidence of diabetes (23.5% vs 11.4% vs 10.1%, P?=?0.001) and hiatal hernia (28.3% vs 14.8% vs 20.3%, P?=?0.01) for obese patients. More patients with BMI >24 were found with adenocarcinoma, compared with the normal-weight group (90.8% vs 90.9% vs 82.5%, P?=?0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6% vs 54.5% vs 66.2%, P?=?0.004). The type of surgery performed, overall blood loss, extent of lymphadenectomy, rate of resections with negative margins, and postoperative complications were not influenced by BMI on univariate and multivariate analysis. CONCLUSIONS:: In our experience, BMI did not affect number of harvested lymph-nodes, rates of negative margins, and morbidity and mortality after esophagectomy for cancer. In our experience, esophagectomy could be performed safely and efficiently in mildly obese patients.

Original languageEnglish (US)
JournalAnnals of surgery
DOIs
StateAccepted/In press - Oct 22 2015

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Esophagectomy
Body Mass Index
Neoplasms
Weights and Measures
Neoadjuvant Therapy
Quality of Health Care
Esophageal Neoplasms
Lymph Node Excision
Adenocarcinoma
Multivariate Analysis
Obesity
Lymph Nodes
Body Weight
Databases
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Melis, M., Meredith, K. L., Weber, J., Siegel, E. M., Mcloughlin, J., Dean, E. M., ... Karl, R. C. (Accepted/In press). Body Mass Index and Perioperative Complications After Esophagectomy for Cancer. Annals of surgery. https://doi.org/10.1097/SLA.0000000000000242

Body Mass Index and Perioperative Complications After Esophagectomy for Cancer. / Melis, Marcovalerio; Meredith, Kenneth L.; Weber, Jill; Siegel, Erin M.; Mcloughlin, James; Dean, E. M.; Shah, Nilay; Karl, Richard C.

In: Annals of surgery, 22.10.2015.

Research output: Contribution to journalArticle

Melis, Marcovalerio ; Meredith, Kenneth L. ; Weber, Jill ; Siegel, Erin M. ; Mcloughlin, James ; Dean, E. M. ; Shah, Nilay ; Karl, Richard C. / Body Mass Index and Perioperative Complications After Esophagectomy for Cancer. In: Annals of surgery. 2015.
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abstract = "BACKGROUND:: Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after esophagectomy for cancer. METHODS:: From our comprehensive esophageal cancer database consisting of 510 patients, we identified 166 obese (BMI ≥30), 176 overweight (BMI 25–29), and 148 normal-weight (BMI 20–24) patients. Malnourished patients (BMI of <20) were excluded. Incidence of preoperative risk factors and perioperative complications in each group were analyzed. RESULTS:: The patient group consists of 420 men and 70 women with a mean age at time of surgery were 64 years (range 28–86 years). The categories of patients (obese, overweight, and normal-weight) were similar in terms of demographics and comorbidities, with the exception of a younger age (62.5 years vs 66.2 years vs 65.3 years, P?=?0.002), and a higher incidence of diabetes (23.5{\%} vs 11.4{\%} vs 10.1{\%}, P?=?0.001) and hiatal hernia (28.3{\%} vs 14.8{\%} vs 20.3{\%}, P?=?0.01) for obese patients. More patients with BMI >24 were found with adenocarcinoma, compared with the normal-weight group (90.8{\%} vs 90.9{\%} vs 82.5{\%}, P?=?0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6{\%} vs 54.5{\%} vs 66.2{\%}, P?=?0.004). The type of surgery performed, overall blood loss, extent of lymphadenectomy, rate of resections with negative margins, and postoperative complications were not influenced by BMI on univariate and multivariate analysis. CONCLUSIONS:: In our experience, BMI did not affect number of harvested lymph-nodes, rates of negative margins, and morbidity and mortality after esophagectomy for cancer. In our experience, esophagectomy could be performed safely and efficiently in mildly obese patients.",
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