[Impact of the body mass index on the prognosis and complication rate after surgical resection of cancers at the oesophagogastric junction].
BACKGROUND
An elevated body mass index (BMI) is associated with an increased incidence of cancer at the gastro-oesophageal junction. Less is known about the postoperative complication rate and prognosis in relation to the BMI.


METHODS
We investigated 108 patients with cancer of the cardia and a BMI below (group 1, n = 56) or above (group 2, n = 52) 25 kg / m (2), who were operated from 2000 to 2006 in our department. According to the Siewert classification, the tumours were subdivided into 3 types. Patients with type I cancers (n = 26) received a transthoracic oesophageal resection with gastric pull up. Patients with type II (n = 61) or type III (n = 21) cancers underwent an extended gastrectomy. The complication rates and survival were analysed.


RESULTS
The complications were pulmonary (respiratory insufficiency n = 12, pneumonia n = 12, bronchitis n = 7, pulmonary embolism n = 2), surgical (anastomotic leakage n = 7, abscesses n = 8, bleeding n = 2, chylus fistula n = 1), or functional (dysphagia n = 5, nausea n = 5, heart burn n = 4, delayed enteral passage n = 6, vomiting n = 9). Patients of group 2 showed more delayed enteral passages (5 vs. 1) and more vomiting (7 vs. 2) than those of group 1. The median stay in the intensive care unit was shorter in group 1 than in group 2 (3 vs. 5 days) (p = 0.021). Overall hospitalisation was 14 days in the mean in both groups. We found no significant difference in the postoperative mortality of 6.5 % (n = 7) between the two groups. Overall survival after a follow-up of 42 months was 34 % (group 1) and 25 % (group 2). The difference did not reach statistical significance (p = 0.961). Patients with an elevated BMI show slightly more complications than those with a lower BMI.


CONCLUSIONS
Our data show that patients with elevated BMI have slightly more complications and an identical long term survival as patients with normal body weight.
Schumacher
G
G
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany. guido.schumacher@charite.de
Schlechtweg
N
N
Chopra
S S
SS
Rösch
T
T
Veltzke-Schlieker
W
W
Thuss-Patience
P
P
Schmidt
S C
SC
Neuhaus
P
P
D015992:Body Mass Index; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002299:Cardia / Q000473:pathology; D003627:Data Interpretation, Statistical; D004943:Esophagogastric Junction; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors