title: Impact of being overweight on the surgical outcomes of patients with gastric cancer: a meta-analysis.
abstract: OBJECTIVE
  To investigate the effect of being overweight on the surgical results of patients with gastric cancer.
  
  
  METHODS
  Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m(2)] or overweight (BMI ≥ 25 kg/m(2)). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software.
  
  
  RESULTS
  This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m(2); 4897 with BMI ≥ 25 kg/m(2)). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
authors.affiliation: Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Xiang-Song
authors.initials: XS
authors.lastname: Wu
authors.forename: Wen-Guang
authors.initials: WG
authors.lastname: Wu
authors.forename: Mao-Lan
authors.initials: ML
authors.lastname: Li
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Yang
authors.forename: Qi-Chen
authors.initials: QC
authors.lastname: Ding
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Jia-Sheng
authors.initials: JS
authors.lastname: Mu
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Ping
authors.initials: P
authors.lastname: Dong
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Lu
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
mesh_terms: D015992:Body Mass Index; D016009:Chi-Square Distribution; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D050177:Overweight / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Body mass index; Gastrectomy; Gastric cancer; Overweight
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