title: Obesity is not associated with increased morbidity in patients undergoing cytoreductive surgery with intraperitoneal chemotherapy.
abstract: OBJECTIVE
  Recent single-institutional series have examined the relationship of body mass index (BMI) in patients undergoing cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) generally without significant increase in serious complications with increasing BMI. This study evaluates the impact of BMI on complication rates using a national cohort.
  
  
  METHODS
  The ACS NSQIP database was queried for patients undergoing concurrent CRS with IPC (2005-2012). Death and serious morbidity (DSM) was the primary outcome. Statistical analyses were performed to determine significant associations between peri-operative factors and DSM.
  
  
  RESULTS
  Of 1,085 patients, there were 30.4% (n = 330) obese (BMI >30) and 32.1% (n = 348) normal weight (BMI 18.5-24.9) patients. DSM rates did not differ between these groups (P = 0.853). Obese patients were more likely to experience post-operative wound (P = 0.017) and renal (P = 0.002) complications. Hypoalbuminemia (OR 7.34; 95% CI 2.27-23.73), prolonged operative time (OR 3.02; 95% CI 1.83-4.97) and concomitant liver resection (OR 3.29; 95% CI 1.31-8.28) were independent risk factors for DSM among obese patients.
  
  
  CONCLUSIONS
  Obesity is not significantly associated with DSM in patients undergoing CRS/IPC, and should not be a major deterrence for surgery. However, obese patients are more likely to experience wound and renal complications and hypoalbuminemia is a strong preoperative risk factor. J. Surg. Oncol. 2016;114:619-624. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Madalyn.peters@uphs.upenn.edu.
authors.forename: Madalyn G
authors.initials: MG
authors.lastname: Neuwirth
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000368:Aged; D015992:Body Mass Index; D010478:Chemotherapy, Cancer, Regional Perfusion; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures; D016208:Databases, Factual; D004067:Digestive System Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D014481:United States
keywords: HIPEC; Obesity; body mass index; cytoreductive surgery; intraperitoneal chemotherapy