Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methodsReportar como inadecuado




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BMC Gastroenterology

, 17:78

Gastroesophageal disorders

Abstract

BackgroundObesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy LG for gastric cancer.

MethodsWe reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy LAG and totally laparoscopic gastrectomy TLG, is more suitable for obese patients.

ResultsA total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group 209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01, and intraoperative blood loss was significantly lower in the non-obese group 113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01. Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group 3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01. 119 9.5% of the non-obese patients had postoperative complications as compared to 44 10.1% of the obese patients P = 0.71. In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.

ConclusionsObesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.

KeywordsLaparoscopic gastrectomy Stomach neoplasms Obesity Body mass index Morbidity AbbreviationsASAAmerican Society of Anesthesiologists

BMIBody mass index

EBLEstimated blood loss

LADGLaparoscopic-assisted distal gastrectomy

LAGLaparoscopic-assisted gastrectomy

LATGLaparoscopic-assisted total gastrectomy

LGLaparoscopic gastrectomy

RCTRandomized controlled trial

SDStandard deviations

TLDGTotally laparoscopic distal gastrectomy

TLGTotally laparoscopic gastrectomy

TLTGTotally laparoscopic total gastrectomy

TNMTumor-node-metastasis





Autor: Ke Chen - Yu Pan - Shu-ting Zhai - Jia-qin Cai - Qi-long Chen - Ding-wei Chen - Yi-ping Zhu - Yu Zhang - Ya-ping Zhang -

Fuente: https://link.springer.com/







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