title: A high body mass index in esophageal cancer patients does not influence postoperative outcome or long-term survival.
abstract: BACKGROUND
  The body mass index (BMI) in the general population has increased over the past decades. A high BMI is a known risk factor for the development of esophageal adenocarcinoma. Several studies on the influence of a high BMI on the postoperative course and survival after esophagectomy have shown contradictory results. The aim of the present study was to determine the influence of a high BMI on postoperative complications and survival among a large cohort of esophageal cancer patients.
  
  
  METHODS
  Patients who underwent an esophagectomy between 1993 and 2010 were divided into three groups according to their BMI: normal weight (<25 kg/m(2)), overweight (25-30 kg/m(2)) or obese (≥ 30 kg/m(2)). Severity of complications was scored according to the Dindo classification, which was divided into three categories: no complications, minor to moderate complications, and severe complications. Long-term survival was determined according to the Kaplan-Meier method.
  
  
  RESULTS
  A total of 736 esophagectomy patients were divided into three groups: normal weight (n = 352), overweight (n = 308), and obese (n = 72). Complications rates were similar for all groups (65-72%, P = 0.241). The incidence of anastomotic leakage was higher among obese patients compared to the other groups (20% vs. 10-12% respectively, P = 0.019), but there was no significant difference between the three groups regarding the severity of complications according to the Dindo classification (P = 0.660) or in 5-year survival rates (P = 0.517).
  
  
  CONCLUSIONS
  A high BMI is not associated with an increased incidence or severity of complications after esophagectomy; however, anastomotic leakage occurred more frequently in obese patients. Five-year survival rates were not influenced by the preoperative BMI. A high BMI is therefore ought not be an exclusion criterion for esophagectomy.
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: R L G M
authors: RL
authors: Blom
authors: S M
authors: SM
authors: Lagarde
authors: J H G
authors: JH
authors: Klinkenbijl
authors: O R C
authors: OR
authors: Busch
authors: M I
authors: MI
authors: van Berge Henegouwen
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000601:surgery; D000368:Aged; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications; D011183:Postoperative Complications; D015996:Survival Rate