Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma

Abstract

Background. To determine the role of body mass index (BMI) in a Western population on outcomes after modified D2 gastrectomy (preserving pancreas and spleen where possible) for gastric cancer. Methods. Eighty-four consecutive patients undergoing an R0 modified D2 gastrectomy for gastric cancer were studied prospectively. Male patients with a BMI of greater than 24.7kgm-2 and female patients with a BMI of greater than 22.6kgm-2 were classified as overweight and compared with control patients with BMIs below these reference values. Results. Thirty-eight of the patients (45%) were classified as overweight. The median BMI of the overweight patients was 27.0kgm-2 (range, 22.7-34.7kgm-2; 27 males) compared with 21.2kgm-2 (range, 15.2-24.7kgm-2, 31 males) for control patients. Operative morbidity and mortality were 26% and 7.9% in overweight patients compared with 22% and 6.5% in control patients (morbidity, χ2 0.240; df = 1; P = 0.624; mortality, χ2 = 0.059; df = 1; P = 0.808). Cumulative survival at 5 years was 52% for overweight patients compared with 55% for control patients (χ2 = 0.15; df = 1; P = 0.7002). In a multivariate analysis, the number of lymph node metastases (hazard ratio, 1.441; 95% confidence interval [CI], 1.159-1.723; P = 0.009) and splenectomy (hazard ratio, 12.111; 95% CI, 9.645-14.577; P = 0.043) were independently associated with the duration of survival. Conclusion. High BMIs were not associated with increased operative risk, and longterm outcomes were similar in the two groups after modified D2 gastrectomy.