title: Impact of visceral fat on laparoscopy-assisted distal gastrectomy.
abstract: BACKGROUND
  Obesity is known to be a preoperative risk factor for gastric cancer surgery. However, the influence of obesity on laparoscopy-assisted distal gastrectomy (LADG) remains controversial. In the present study, we evaluated several obesity parameters and investigated the influence of obesity on the surgical outcomes of LADG for gastric cancer.
  
  
  METHODS
  Between January 2010 and July 2011, 84 patients who underwent LADG for gastric cancer were enrolled. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured in cross-sectional CT scan using SlimVision(®) software. Patients were classified into two groups by the degree of BMI or VFA. Surgery time and blood loss were compared between each two groups. Predictive factors for perioperative complications were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  There were no significant differences in surgery time or blood loss between patients with high and low BMIs. In contrast, high VFA patients had significantly longer surgery times (p=0.0047) and higher estimated blood loss (p=0.0034) than low VFA patients. By univariate and multivariate analyses, only a high VFA significantly predicted perioperative complications (p=0.0162, p=0.0288).
  
  
  CONCLUSIONS
  We suggest that VFA is more accurate than BMI in predicting surgery time, blood loss, and perioperative complications associated with LADG for gastric cancer. The visceral fat area could be efficiently assessed before laparoscopic surgery for gastric cancer in obese patients.
authors: Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan. m1yak114@yahoo.co.jp
authors: Akira
authors: A
authors: Miyaki
authors: Kazuhiro
authors: K
authors: Imamura
authors: Rie
authors: R
authors: Kobayashi
authors: Makoto
authors: M
authors: Takami
authors: Jun
authors: J
authors: Matsumoto
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056128:Obesity, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome