Y. Kikuchi1, H. Takeuchi1, H. Kawakubo1, K. Fukuda1, R. Nakamura2, T. Takahashi2, N. Wada1, Y. Saikawa1, T. Omori1, Y. Kitagawa1 1Keio University School Of Medicine,Department Of Surgery,Shinjuku, TOKYO, Japan 2Keio University School Of Medicine,Tumor Center,Shinjuku, TOKYO, Japan
Introduction: Recently, the proportion of overweight esophageal cancer patients has been increasing according to a change of dietary habits and progress in endoscopic diagnosis. In this study, we clarified the relations between obesity and postoperative complications after esophagectomy in patients with esophageal cancer.
Methods: Between January 2008 and March 2014, a total of 215 patients with esophageal cancer who underwent an esophagectomy was included. We qualified the body mass index (BMI), visceral fat area (VFA) and subcutaneous fat area (SFA) on cross-sectional computed tomography scans obtained at the umbilicus level with CYNAPSE VINCENT™. Patients were divided to two groups according to their BMI group (<25 or ≧25kg/m ²) , VFA group (<100 or ≧100cm ²), which are defined by Japan Society for the Study of Obesity and SFA group (<100 or ≧100cm ²).
Results:A total of 215 patients were divided to two groups according to their BMI, VFA, and SFA: normal BMI (n=178) and high BMI (n=37), normal VFA (n=138) or high VFA (n=77), and normal SFA (n=134) and high BMI (n=81) , respectively. Operative time was significantly longer in high BMI than normal BMI (561 vs 526 minutes, P=0.043) and longer in high SFA than normal SFA (552 vs 520 minutes, P=0.002), but operative blood loss was similar in each groups. Maximum level of postoperative CRP was significantly higher in high BMI than normal BMI (17.1 vs 13.7mg/dL , P＜0.001) , higher in high VFA than normal VFA (16.1 vs 13.2mg/dL, P＜0.001), and higher in high SFA than normal SFA (15.5 vs 13.5, P=0.004). PaO2/FiO2 ratio of postoperative day1 was significant lower in high BMI than normal BMI (326 vs 384, P＜0.001) , lower in high VFA than normal VFA (341 vs 393, P＜0.001), and lower in high SFA than normal SFA(342 vs 394, P＜0.001). The incidence of anastomotic leakage was significant higher in high SFA than normal SFA (28% vs 10%, P=0.001), higher in high BMI than normal BMI (27% vs 15%, P=0.087), and higher in high VFA than normal VFA (23% vs 14%, P=0.076). Surgical site infection was significant higher in high SFA than normal SFA (38% vs 19%, P=0.003). Complications rates were similar in each groups.
Conclusion:Obesity was relation to operative time, maximum level of postoperative CRP, PaO2/FiO2 ratio of postoperative day1. High BMI and VFA were not associated with an increased incidence of complications after esophagectomy; however, anastomotic leakage and surgical site infection occurred more frequently in obese patients. Therefore, we should pay careful attention to obese patients with esophageal cancer for management after esophagectomy. Moreover, it is useful to examine SFA in obese patients with esophageal cancer.