title: Is There any Role of Visceral Fat Area for Predicting Difficulty of Laparoscopic Gastrectomy for Gastric Cancer?
abstract: OBJECTIVE
  Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications.
  
  
  METHODS
  A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI (<25 kg/m(2) and ≥25 kg/m(2)) and VFA (<100 cm(2) and ≥100 cm(2)). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups.
  
  
  RESULTS
  The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively).
  
  
  CONCLUSIONS
  VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ho-Jung
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Son
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Long-Hai
authors.initials: LH
authors.lastname: Cui
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Cheulsu
authors.initials: C
authors.lastname: Byun
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Hur
authors.affiliation: Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jei Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Kim
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Sang-Uk
authors.initials: SU
authors.lastname: Han
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yong Kwan
authors.initials: YK
authors.lastname: Cho
keywords: Gastrectomy; Intra-abdominal fat; Laparoscopic; Obesity; Stomach neoplasms