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High BMI does not increase major complication risk after laparoscopic gastrectomy

13 May 2019

High body mass index (BMI) does not appear to increase the risk of major complications during laparoscopic gastrectomy for gastric cancer, reports a recent meta-analysis.

Accessing the databases of PubMed and Embase, researchers selected for studies that compared outcomes of laparoscopic gastrectomy between high and low BMI patients with gastric cancer. Only those that included common complications, such as anastomotic leakage, pancreatic fistula and wound infections, in the final analysis were eligible for inclusion.

The selection criteria yielded 16 retrospective studies, corresponding to a total of 9,572 gastric cancer patients. A pooled analysis of 15 of these studies showed that mean operation time was significantly prolonged in patients with high BMI (weighted mean difference [WMD], 16.22; 95 percent CI, 14.10–18.34; p<0.001).

Moreover, those with high BMI also had significantly fewer lymph nodes retrieved (WMD, –2.11; –3.14 to –1.07; p<0.001) and greater amount of intraoperative blood loss (WMD, 23.43; 20.05–26.81; p<0.001).

The significantly more difficult procedure in high BMI patients, translated to a significantly higher likelihood of postoperative complications (relative risk [RR], 1.26; 1.11–1.43; p<0.001). Specifically, the risks of postoperative wound infections (RR, 1.62; 1.15–2.29; p<0.01) and ileus (RR, 1.80; 1.05–3.09; p<0.05) were elevated.

However, the risks of major surgery-related complications remained comparable between normal and high BMI patients. Among such complications were anastomotic leakage and stenosis, intra-abdominal infections, pancreatic fistula, duodenal stump leakage, gastric stasis, pulmonary infection, and anastomotic bleeding.

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