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Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501)

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Abstract

Background

The impact of overweight on the outcome of gastrectomy with lymphadenectomy is controversial, and data from a well-controlled, randomized study are needed to identify a possible relationship.

Methods

We used data from 523 patients registered for a prospective randomized trial comparing D2 and extended para-aortic D3 lymphadenectomy to compare the effects of body mass index (BMI) and the extent of lymphadenectomy for the development of general or major surgical complications (anastomotic leakage, abdominal abscess, and pancreatic fistula).

Results

Seventy-seven patients were classified as overweight with BMI ≥ 25, and 38 and 39 of these patients underwent a D2 or D3 lymphadenectomy, respectively. Among the 446 patients classified as nonoverweight with BMI < 25, 225 received D2 and 221 received D3 lymphadenectomy. Surgical complications, operation time, and blood loss were statistically significantly associated with BMI, and logistic regression analysis revealed that overweight directly affected the occurrence of surgical complications even after considering operation time and blood loss as intermediate factors instead of outcome variables. Among patients undergoing D2 lymphadenectomy, being overweight increased the risk for surgical complications and blood loss, whereas overweight was associated with only blood loss and operation time among patients receiving D3 lymphadenectomy.

Conclusions

Overweight increased the risk of surgical complications in patients undergoing gastrectomy both directly and indirectly through operation time and blood loss. The impact of overweight on surgical complications was more evident in patients undergoing a D2 dissection.

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Acknowledgments

Supported in part by Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare and the Second Term Comprehensive 10-Year Strategy for Cancer Control by the Ministry of Health and Welfare, Japan.

The authors thank Dr. Yoshimura for help with the statistical analysis, Ms. Hongo for data management, and Ms. Sugimoto for secretarial assistance.

Participating institutions and chief participants: National Cancer Center Hospital (M. Sasako, T. Sano), Niigata Cancer Center Hospital (A. Nashimoto, H. Yabuzaki), National Shikoku Cancer Centre (A. Kurita, Y. Kubo), Osaka Medical Center for Cancer and Cardiovascular Diseases (M. Hiratsuka, I. Miyashiro), Osaka National Hospital (K.Fujitani, M. Hirao), National Cancer Centre Hospital East (T. Kinoshita), Tokyo Metropolitan Komagome Hospital (K. Arai, Y. Iwasaki), Aichi Cancer Centre (T. Kito, Y. Yamamura), Osaka Medical College (K. Okajima, M. Tanigawa), International Medical Centre of Japan (O. Kobori, T. Shimizu), Sakai City Hospital, Kanagawa Cancer Centre (H. Furukawa, H. Imamura), Tokyo Metropolitan Bokuto Hospital (M. Kitamura, S. Inoue), Nagaoka Chuo General Hospital (T. Yoshikawa, T. Shimizu), Niigata City General Hospital (K. Aizawa), Cancer Institute Hospital (K. Ota, S. Oyama), Kyoto Second Red Cross Hospital (H. Tokuda, S. Takahashi), Saitama Cancer Centre, Hiroshima City Hospital (Y. Tanaka, K. Uchida), Kanazawa University (K. Miwa, T. Fujimura), Gifu Municipal Hospital (H. Tanemura, H. Oshita), Kagoshima University (T. Aiko, S. Hokita), Iwate Medical University (M. Terashima, K. Saito), and Okayama University (H. Isozaki).

Author information

Authors and Affiliations

  1. Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan

    Toshimasa Tsujinaka MD

  2. Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Mitsuru Sasako MD, Takeshi Sano MD & Hitoshi Katai MD

  3. Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan

    Seiichiro Yamamoto PhD & Yukinori Kurokawa MD

  4. Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan

    Atsushi Nashimoto MD

  5. Department of Surgery, National Shikoku Cancer Center, Matsuyama, Japan

    Akira Kurita MD

  6. Department of Surgery, International Medical Center of Japan, Tokyo, Japan

    Toshio Shimizu MD

  7. Department of Surgery, Sakai Municipal Hospital, Sakai, Japan

    Hiroshi Furukawa MD

  8. Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

    Satoru Inoue MD

  9. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan

    Masahiro Hiratsuka MD

  10. Department of Surgery, National Cancer Center East, Tokyo, Japan

    Taira Kinoshita MD

  11. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Kuniyoshi Arai MD

  12. Department of Surgery, Aichi Cancer Center, Aichi, Japan

    Yoshitaka Yamamura MD (for the Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group)

Authors
  1. Toshimasa Tsujinaka MD
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  2. Mitsuru Sasako MD
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  3. Seiichiro Yamamoto PhD
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  4. Takeshi Sano MD
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  5. Yukinori Kurokawa MD
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  6. Atsushi Nashimoto MD
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  7. Akira Kurita MD
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  8. Hitoshi Katai MD
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  9. Toshio Shimizu MD
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  10. Hiroshi Furukawa MD
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  11. Satoru Inoue MD
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  12. Masahiro Hiratsuka MD
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  13. Taira Kinoshita MD
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  14. Kuniyoshi Arai MD
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  15. Yoshitaka Yamamura MD
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Corresponding author

Correspondence to Toshimasa Tsujinaka MD.

Additional information

Members of the Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group are listed in the Acknowledgments.

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Tsujinaka, T., Sasako, M., Yamamoto, S. et al. Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501). Ann Surg Oncol 14, 355–361 (2007). https://doi.org/10.1245/s10434-006-9209-3

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  • DOI: https://doi.org/10.1245/s10434-006-9209-3

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