title: Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer.
abstract: BACKGROUND
  Laparoscopic distal gastrectomy for gastric cancer has been firmly established in recent decades but still is a difficult procedure, especially for obese patients, as with open surgery. This study aimed to evaluate the perioperative outcome of total laparoscopic distal gastrectomy (TLDG) for early gastric cancer patients with a body mass index (BMI) exceeding 25 kg/m(2) and to consider countermeasures to this.
  
  
  METHODS
  Perioperative outcomes were compared between 42 patients with a BMI exceeding 25 kg/m(2) [overweight or obese group (OWG)] and 174 patients with a BMI lower than 25 kg/m(2) [normal or underweight group (NWG)] who underwent TLDG between September 2010 and December 2012.
  
  
  RESULTS
  The BMI was 26.0 ± 1.4 kg/m(2) in the OWG group and 22.0 ± 2.1 kg/m(2) in the NWG group (P < 0.001). The groups did not differ in terms of age, sex, American Society of Anesthesiologists score, presence of diabetes, number of retrieved lymph nodes, number of metastatic lymph nodes, or metastatic lymph node ratio. The two groups did not differ significantly with respect to the extent of lymph node dissection [OWG: D1 (11.9 %), D1+ (66.7 %), D2 (21.4 %) vs NWG: D1 (5.2 %), D1+ (51.7 %), D2 (43.1 %); P = 0.020] or tumor size (OWG: 25.5 ± 20.2 mm vs NWG: 33.0 ± 17.2 mm; P = 0.037). Differences in operation time (OWG: 212 ± 31 min vs NWG: 200 ± 35 min; P = 0.005) and estimated blood loss (OWG: 15 ± 22 ml vs NWG: 10 ± 34 ml; P = 0.013) seemed to have a minimal impact clinically. Postoperative complications including infectious complications and recovery after surgery did not differ between the two groups.
  
  
  CONCLUSIONS
  For overweight and obese patients, TLDG was managed safely. The procedure was considered to be difficult but sufficiently feasible.
authors.affiliation: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwa-no-ha, Kashiwa, Chiba, 277-8577, Japan, msugimot@east.ncc.go.jp.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Hidehito
authors.initials: H
authors.lastname: Shibasaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery*; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000601:surgery; D050177:Overweight / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome