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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)

¹ Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan
² Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
³ Cancer Information and Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan
⁴ Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
⁵ Department of Surgery, National Shikoku Cancer Center, Matsuyama, Japan
⁶ Department of Surgery, International Medical Center of Japan, Tokyo, Japan
⁷ Department of Surgery, Sakai Municipal Hospital, Sakai, Japan
⁸ Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
⁹ Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
¹⁰ Department of Surgery, National Cancer Center East, Tokyo, Japan
¹¹ Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
¹² Department of Surgery, Aichi Cancer Center, Aichi, Japan

Correspondence: Address correspondence and reprint requests to: Toshimasa Tsujinaka, MD, E-mail: toshi{at}onh.go.jp

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 paraaortic 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.

Key Words: Overweight • BMI • Complication • Gastric cancer • RCT • JCOG

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