J Gastric Cancer.  2015 Sep;15(3):151-158. 10.5230/jgc.2015.15.3.151.

Is There any Role of Visceral Fat Area for Predicting Difficulty of Laparoscopic Gastrectomy for Gastric Cancer?

• Shin HJ
• Son SY
• Cui LH
• Byun C
• Hur H
• Lee JH
• Kim YC
• Han SU
• Cho YK

• KMID: 2372200
• DOI: http://doi.org/10.5230/jgc.2015.15.3.151

Abstract

PURPOSE
Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications.
MATERIALS AND METHODS
A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI (<25 kg/m2 and > or =25 kg/m2) and VFA (<100 cm2 and > or =100 cm2). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups.
RESULTS
The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively).
CONCLUSIONS
VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.

Keyword

Stomach neoplasms; Laparoscopic; Gastrectomy; Obesity; Intra-abdominal fat

MeSH Terms

Body Mass Index
Gastrectomy*
Humans
Intra-Abdominal Fat*
Learning
Learning Curve
Length of Stay
Obesity
Operative Time
Postoperative Complications
Stomach Neoplasms*
Surgeons

Figure

• 

  Fig. 1 Correlation between body mass index (BMI) and visceral fat area (VFA). The correlation efficiency was lower between BMI and VFA than between BMI and total fat area.

• 

  Fig. 2 Overall survival of patients according to obesity and surgeon experience. Although the difference was not statistically significant, the overall survival rate tended to be lower in patients with high visceral fat area (VFA) in the 'before learning curve' group. BMI = body mass index; BMI-H = BMI ≥25 kg/m2; VFA-L = VFA<100 cm2; VFA-H = VFA≥100 cm2

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