title: Overweight patients operated on for cancer of the esophagus survive longer than normal-weight patients.
abstract: BACKGROUND
  Esophageal adenocarcinoma is often associated with obesity, and a 5 Kg m(-2) increase in body mass index (BMI) has, in fact, been found to be strongly associated with the risk of this type of cancer (RR, 1.52; p < 0.0001). Esophagectomy with lymphoadenectomy is the mainstay of therapy for these patients. The aim of this study was to assess and compare the surgical and oncological outcomes as well as the survival rates of underweight, normal weight, overweight, and obese patients following esophagectomy for esophageal cancer.
  
  
  METHODS
  Data relative to 1,127 patients with esophageal adenocarcinoma presenting at a specialized tertiary hospital (the Center of Esophageal Diseases for the Veneto Region) between 2000 and 2008 were prospectively collected. The 278 subjects whose BMI values before disease onset were available and underwent esophagectomy were enrolled in the study. Sixty-one of the 278 patients were classified as obese (BMI >30), 121 were classified as overweight (BMI, 25-29.9), 81 were classified as normal weight (BMI <24.9), and 15 ones as underweight (BMI <20). The outcome and survival of the four groups were compared. Frequency and survival analyses were carried out.
  
  
  RESULTS
  The rate of R0 esophagectomy and the incidence of toxicity during neoadjuvant chemotherapy were similar in the four groups. Respiratory complications after R0 esophagectomy seemed to be more frequent in the underweight and normal-weight patients group (p < 0.01). Moreover, underweight patients had a significantly higher rate of septic, cardiovascular, and metabolic postoperative complications. The 121 overweight patients had a better overall survival rate compared to normal weight and obese patients (p = 0.05). This difference was not significant if patients were stratified in stages I or II or stages III or IV.
  
  
  CONCLUSIONS
  Overweight patients seem to respond better to esophageal cancer and esophagectomy with respect to normal-weight ones. This data seem to suggest that in spite of several unfavorable features, a moderate increase of weight may be helpful to survive after esophagectomy for cancer.
authors.affiliation: Department of Oncological Surgery, Veneto Oncological Institute (IOV-IRCCS), via Gattamelata 64, 35128, Padova, Italy. marcoscarpa73@yahoo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Matteo
authors.initials: M
authors.lastname: Cagol
authors.forename: Silvia
authors.initials: S
authors.lastname: Bettini
authors.forename: Rita
authors.initials: R
authors.lastname: Alfieri
authors.forename: Amedeo
authors.initials: A
authors.lastname: Carraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Trevellin
authors.forename: Luca M
authors.initials: LM
authors.lastname: Saadeh
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.forename: Roberto
authors.initials: R
authors.lastname: Vettor
authors.forename: Ermanno
authors.initials: E
authors.lastname: Ancona
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications; D011446:Prospective Studies; D015996:Survival Rate