Short-term and long-term outcomes of oesophagogastric surgery for cancer in obese and normal weight patients

Abstract

Background: Obesity is generally considered to be associated with worse surgical outcome and impaired oncological prognosis. The impact of pre-therapeutic body mass index (BMI) in patients with oesophagogastric cancer on the surgical outcome is controversially discussed. Methods: We retrospectively examined 730 patients who had undergone curative treatment for oesophagogastric cancer at the Medical Center of the University of Freiburg (1996–2015). Patients were divided in groups according to pre-therapeutic BMI (underweight (UW): <18.5 kg/m2; normal weight (NW): 18.5–25 kg/m2; overweight (OW): 25–30 kg/m2; and obese (OB): >30 kg/m2). Results: Median BMI was 24.7 kg/m2. Forty-two patients were UW, 337 NW, 263 OW and 84 OB. No significant differences between the groups (UW/NW/OW/OB) in operating time, hospital stay, perioperative complication rate and in-hospital mortality were found. Pre-therapeutic BMI was significantly associated with 5-year survival (UW: 22%, NW: 37%, OW: 51%, OB: 50%, P < 0.001). Multivariate analysis identified UW/NW (BMI <25 kg/m2) as an independent risk factor for poor survival (relative risk 1.38, P = 0.001) among high American Society of Anesthesiologists score, old age, positive resection margin and high cancer stage according to the Union Internationale Contre le Cancer (UICC). Conclusion: In oesophagogastric cancer, OW and OB patients can be treated surgically without impaired perioperative outcome and expect improved long-term survival compared to patients with a BMI <25 kg/m2.