title: Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer.
abstract: BACKGROUND
  The prevalence of obesity is increasing in the United States. Obesity has been associated with worse surgical outcomes, but its impact on long-term outcomes in gastric cancer is unclear. The aim of this study was to evaluate the effects of being overweight on surgical and long-term outcomes for patients with gastric cancer.
  
  
  METHODS
  Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2007 were identified from a prospectively collected gastric cancer database. Overweight was defined as a body mass index (BMI) of 25 kg/m(2) or higher. Clinical outcomes of overweight and nonoverweight patients were compared.
  
  
  RESULTS
  From the total population of 1,853 patients, 1,125 (60.7%) were overweight. Overweight patients tended to have more proximal tumors and a lower T stage. Accurate complication data were available on a subset of patients from 2000 to 2007. A BMI of ≥25 was associated with increased postoperative complications (47.9 vs. 35.8%, p < 0.001). This was mainly due to an increase in the rate of wound infections (8.9 vs. 4.7%, p = 0.02) and anastomotic leaks (11.8 vs. 5.4%, p = 0.002). Multivariate logistic regression analysis showed that higher BMI, total gastrectomy, and use of neoadjuvant chemotherapy were associated with increased wound infection and anastomotic leak. Overweight patients were less likely to have adequate lymph node staging (73.3 vs. 79.2%, p = 0.047). There was no difference in overall survival or disease-specific survival between the two groups.
  
  
  CONCLUSIONS
  Increased BMI is a predictor of increased postoperative complications, including anastomotic leak, but it is not a predictor of survival in gastric cancer.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Kai A
authors.initials: KA
authors.lastname: Bickenbach
authors.forename: Brian
authors.initials: B
authors.lastname: Denton
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult