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However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) ...
J Gastrointest Surg (2015) 19:226–233 DOI 10.1007/s11605-014-2686-y

ORIGINAL ARTICLE

Impact of Body Mass Index on Surgical Outcomes after Esophagectomy for Patients with Esophageal Squamous Cell Carcinoma Tsuyoshi Hasegawa & Naoshi Kubo & Masaichi Ohira & Katsunobu Sakurai & Takahiro Toyokawa & Yoshito Yamashita & Sadaaki Yamazoe & Kenjiro Kimura & Hisashi Nagahara & Ryosuke Amano & Masatsune Shibutani & Hiroaki Tanaka & Kazuya Muguruma & Hiroshi Ohtani & Masakazu Yashiro & Kiyoshi Maeda & Kosei Hirakawa

Received: 7 August 2014 / Accepted: 16 October 2014 / Published online: 15 November 2014 # 2014 The Society for Surgery of the Alimentary Tract

Abstract Background Patients with overweight reportedly have more comorbidities, including diabetes mellitus and cardiovascular disease, and longer operating times as well as more blood loss during surgery compared with those with normal weight. However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We hypothesized that overweight has a negative impact on short-term surgical outcomes after esophagectomy for patients with ESCC. Methods A total of 304 patients who underwent transthoracic esophagectomy for ESCC were included in this study. Body mass index (BMI) was classified into three categories, 25.00 (kg/m2), defined as low, normal, and high BMI, respectively, according to the World Health Organization criteria. We investigated the association of BMI status with patient demographics and surgical outcomes after esophagectomy for patients with ESCC. In addition, overall survival and relapse-free survival stratified by BMI were compared. Results Fifty-nine (19.4 %) and 41 (13.4 %) patients were classified to low BMI and high BMI, respectively. The high-BMI group had significantly higher comorbidity rates of diabetes mellitus (p25 kg/m2] reportedly have compromised cardiorespiratory systems, including reduced expiratory reserve volume and cardiac remodeling.1, 2 They also have a higher incidence of medical comorbidities, including hypertension, diabetes

J Gastrointest Surg (2015) 19:226–233

mellitus (DM), and cardiovascular disease compared with patients with a normal weight.3, 4Moreover, compared with patients with a normal weight, various types of surgery for patients with high BMI require longer operating times and are associated with more blood loss during surgery owing to – increased visceral adipose tissue.5 7 Transthoracic esophagectomy accompanied with radical lymphadenectomy, which is the main curative treatment for resectable esophageal squamous cell carcinoma (ESCC), is highly invasive because of the incisions required into the abdominal and thoracic walls and the lengthy operation time. These factors lead to a substantially higher rate of postoperative complications and hospital mortality.8, 9 Esophagectomy for high-BMI patients with ESCC is supposed to be associated with a significant hazard and stress to the patients’ compromised cardiovascular systems, which lead to worse postoperative outcomes in patients with high BMI, including increased rates of pulmonary or cardiovascular complications. However, the impact of high BMI on short-term surgical outcomes after esophagectomy for patients with ESCC has not been fully discussed. Hence, we hypothesized that high BMI has a negative impact on shortterm surgical outcomes after esophagectomy for patients with ESCC. The aim of this study was to clarify the influence of high BMI on short-term surgical outcomes after esophagectomy for patients with ESCC. In addition, we investigated the influence of high BMI on long-term results and the relationships between being underweight (BMI