title: Does obesity affect outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for disseminated mucinous appendiceal neoplasms?
abstract: BACKGROUND
  Obesity has been described as a risk factor for surgical complications and may play a prominent role in the progression, recurrence, and survival rates of various cancers. Our objective was to investigate the impact of being overweight or obese on perioperative and oncologic outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) for peritoneal carcinomatosis (PC) from mucinous appendiceal neoplasms (MAN).
  
  
  METHODS
  From a prospectively maintained database (2001-2010) of CRS/HIPEC for PC from MAN, we evaluated the body mass index (BMI) of patients, categorizing them into normal weight (NW < 25 kg/m(2)), overweight (OW = 25 to 29.9 kg/m(2)), and obese (OB ≥ 30 kg/m(2)). We compared the perioperative and oncologic outcomes among groups.
  
  
  RESULTS
  Of the 282 patients in the database, 234 had BMI data available, and 81, 79, and 74 patients were categorized as NW, OW, and OB, respectively. Although there was a trend toward increased risk of overall complications, wound infections, deep vein thrombosis, respiratory and renal complications, and anastomotic leaks in the OW and OB groups, these differences only achieved statistical significance for renal (p = 0.03) and pulmonary (p = 0.02) complications in the OW and OB groups, respectively. The 5-year survival rate for NW, OW, and OB patients was 63.9, 48, and 54.4 %, respectively (p = 0.63). The median time to progression was 21.1 (NW), 21.7 (OW), and 23.9 (OB) months (p = 0.83).
  
  
  CONCLUSIONS
  OW and OB patients may have an increased risk of renal and pulmonary complications, respectively. Obesity has no major impact on perioperative mortality and long-term oncologic outcomes in patients undergoing CRS/HIPEC for MAN.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA, polancopm@upmc.edu.
authors.forename: Patricio M
authors.initials: PM
authors.lastname: Polanco
authors.forename: Alvaro I
authors.initials: AI
authors.lastname: Sanchez
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.forename: Matthew
authors.initials: M
authors.lastname: Holtzman
authors.forename: Steven
authors.initials: S
authors.lastname: Ahrendt
authors.forename: James
authors.initials: J
authors.lastname: Pingpank
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000150:complications / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001063:Appendiceal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015992:Body Mass Index; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009765:Obesity / Q000503:physiopathology*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate