title: The benefits of laparoscopically assisted distal gastrectomy for obese patients.
abstract: BACKGROUND
  In Japan, the number of obese patients with gastric cancer is increasing. This study aimed to evaluate the advantages of laparoscopically assisted distal gastrectomy (LADG) for obese patients relative to those of conventional distal gastrectomy (DG).
  
  
  METHODS
  Between January 2004 and June 2009, a total of 197 consecutive patients with gastric carcinoma underwent curative distal gastrectomy with Billroth 1 reconstruction in the Gunma University Hospital. The patients were assigned to undergo LADG (n = 120) or DG (n = 77) according to the depth of tumor invasion and lymph node status. A body mass (BMI) of 25 kg/m(2) or higher was defined as obesity, and the amounts of blood loss, the operating time, the number of lymph nodes dissected, and the postoperative complications experienced by obese and nonobese patients were compared.
  
  
  RESULTS
  None of the patients in the LADG group required conversion to laparotomy. In the DG group, significantly fewer lymph nodes were retrieved from the obese patients (22.5 ± 3.4) than from the nonobese patients (31.9 ± 2.0; P < 0.05). However, among the obese patients, the number of lymph nodes retrieved did not differ significantly between the LADG and DG groups. In the LADG group, the obese patients had a longer operating time (206.6 ± 6.3 vs. 192.0 ± 3.1 min; P < 0.05) and a greater estimated blood loss (158.2 ± 24.7 vs. 101.9 ± 10.4 ml; P < 0.05) than the nonobese patients. The estimated blood loss correlated the surgical procedures and BMI. No significant difference in postoperative complications was noted between the obese and nonobese groups after each procedure.
  
  
  CONCLUSIONS
  Relative to DG, LADG did not affect the radicality of the procedure for the obese patients, and there is no significant difference in the operating time. The estimated blood loss was significantly less for LADG than for DG. Surgeons should elect to perform LADG for obese patients with gastric cancer.
authors.affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan. tetsuro@med.gunma-u.ac.jp
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ohno
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ando
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogawa
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yanai
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Toyomasu
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Ogata
authors.forename: Ryuusuke
authors.initials: R
authors.lastname: Aihara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Asao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*