Increased fat content and body shape have little effect on the accuracy of lymph node retrieval and blood loss in laparoscopic distal gastrectomy for gastric cancer.
BACKGROUND
Fat volume and large abdominal shape are known to disrupt the procedures of lymph node retrieval used in gastric cancer surgery. The present study examined the effect of increasing fat content on surgical outcomes, including estimated blood loss and the number of lymph nodes retrieved during gastrectomy.


METHODS
Of 154 patients, 50 underwent the conventional open procedure (OPEN) and 104 underwent laparoscopy-assisted distal gastrectomy (LADG). The BMI-related factors of total fat, subcutaneous fat, and visceral fat area, as well as the peritoneum-celiac axis distance were calculated by computed tomography. Regression analysis was used to determine the effects of BMI-related factors that obstruct the surgical procedures on the specific outcomes of estimated blood loss and the number of lymph nodes retrieved.


RESULTS
In the OPEN, but not in the LADG, increases in all BMI-related factors were related to increases in estimated blood loss. The increases in BMI, subcutaneous fat, and the peritoneum-celiac axis distances were related to decreased numbers of retrieved lymph nodes only in the OPEN. Only the factor of visceral fat at the celiac level was modestly associated with a decreased number of dissected lymph node in both groups.


CONCLUSIONS
The present study demonstrated that increased fat content and large body shape have little effect on the number of lymph nodes retrieved and blood loss in LADG. However, for patients undergoing conventional open distal gastrectomy, increased fat content and large body shape do impact on the amount of blood lost and the number of lymph nodes retrieved.
Hiki
Naoki
N
Gastroenterological Center, Department Gastroenterological Surgery, Cancer Institute ARIAKE Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake Koto-ku, Tokyo, 135-8550, Japan. naoki.hiki@jfcr.or.jp
Fukunaga
Tetsu
T
Yamaguchi
Toshiharu
T
Ogura
Toshihiro
T
Miyata
Satoshi
S
Tokunaga
Masanori
M
Ohyama
Shigekazu
S
Sano
Takeshi
T
D050153:Abdominal Fat / Q000473:pathology*; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*