title: Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer.
abstract: BACKGROUND
  After adopting preoperative assessment of the perigastric vessels using 3D-CT and standardization of the procedures, obesity still influences smooth laparoscopy assisted gastrectomy (LAG). We evaluated the impact of body mass index (BMI) and area of visceral fat tissue on the risks of LAG.
  
  
  METHODS
  Sixty-six patients who underwent LAG for gastric cancer were included. The patients were divided into two groups by BMI (<25 BMI-L group: n = 53; ≥25 BMI-H group: n = 13) and area of intraperitoneal fat tissue (<100 cm(2) AF-L group: n = 35; ≥100 cm(2) AF-H group: n = 31), respectively. Fat scan(®), which was computer software operating on abdominal CT, was used to measure the visceral fat areas (VFA). The incidence of postoperative complications, operation time, intraoperative blood loss, and number of dissected lymph nodes were compared between each two groups.
  
  
  RESULTS
  The incidence of postoperative complications of BMI-L and BMI-H groups was 11.3% and 30%, respectively (p = 0.18). The mean blood loss was 85 and 134 g, respectively (p = 0.21). There were no significant differences in operation time and the number of retrieved LNs. The incidence postoperative complications (29%) and mean blood loss (148 g) of then VFA-H group were significantly higher than those of the VFA-L group (5.7%, 48 g). The number of retrieved LNs of the VFA-H group (n = 25) was significantly lower than that of the VFA-L group (n = 34). There was no significant difference in operation time.
  
  
  CONCLUSIONS
  In the VFA-H group, the incidence of postoperative complications and intraoperative blood loss increased, and the dissected number of LNs decreased. The area of visceral fat tissue was useful to predict risks of LAG and postoperative complications with higher precision compared with BMI.
authors.affiliation: Department of Digestive Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Kurita
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishioka
authors.forename: Shinya
authors.initials: S
authors.lastname: Morimoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyatani
authors.forename: Masato
authors.initials: M
authors.lastname: Komatsu
authors.forename: Chie
authors.initials: C
authors.lastname: Mikami
authors.forename: Hideya
authors.initials: H
authors.lastname: Kashihara
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D050152:Intra-Abdominal Fat; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome