title: Effect of obesity on intraoperative bleeding volume in open gastrectomy with D2 lymph-node dissection for gastric cancer.
abstract: BACKGROUND
  To investigate the effect of obesity on open gastrectomy with D2 lymph-node dissection.
  
  
  METHODS
  Between January 2005 and March 2007, 100 patients with preoperatively diagnosed gastric cancer who underwent open gastrectomy with D2 lymph-node dissection were enrolled in this study. Of these, 61 patients underwent open distal gastrectomy (ODG) and 39 patients underwent open total gastrectomy (OTG). Patients were classified as having a high body-mass index (BMI; >/= 25.0 kg/m2; n = 21) or a normal BMI (<25.0 kg/m2; n = 79). The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. Patients were classified as having a high VFA (>/= 100 cm2; n = 34) or a normal VFA (<100 cm2; n = 66). The relationship between obesity and short-term patient outcomes after open gastrectomy was evaluated. Patients were classified as having high intraoperative blood loss (IBL; >/= 300 ml; n = 42) or low IBL (<300 ml; n = 58). Univariate and multivariate analyses were used to identify predictive factors for high IBL.
  
  
  RESULTS
  Significantly increased IBL was seen in the following: patients with high BMI versus normal BMI; patients with gastric cancer in the upper third of the stomach versus gastric cancer in the middle or lower third of the stomach; patients who underwent OTG versus ODG; patients who underwent splenectomy versus no splenectomy; and patients with high VFA versus low VFA. BMI and VFA were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in morbidity between the high IBL group and the low IBL group. Multivariate analysis revealed that patient age, OTG and high BMI or high VFA independently predicted high IBL.
  
  
  CONCLUSIONS
  It is necessary to perform operative manipulations with particular care in patients with high BMI or high VFA in order to reduce the IBL during D2 gastrectomy.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. hirochik@urahp.yokohama-cu.ac.jp.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.forename: Hidetaka A
authors.initials: HA
authors.lastname: Ono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Syoichi
authors.initials: S
authors.lastname: Fujii
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada