Department of Digestive Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
Surg Endosc. 2011 Dec;25(12):3825-30. doi: 10.1007/s00464-011-1798-7. Epub 2011 Jun 18.
After adopting preoperative assessment of the perigastric vessels using 3D-CT and standardization of the procedures, obesity still influences smooth laparoscopy assisted gastrectomy (LAG). We evaluated the impact of body mass index (BMI) and area of visceral fat tissue on the risks of LAG.
Sixty-six patients who underwent LAG for gastric cancer were included. The patients were divided into two groups by BMI (<25 BMI-L group: n = 53; ≥25 BMI-H group: n = 13) and area of intraperitoneal fat tissue (<100 cm(2) AF-L group: n = 35; ≥100 cm(2) AF-H group: n = 31), respectively. Fat scan(®), which was computer software operating on abdominal CT, was used to measure the visceral fat areas (VFA). The incidence of postoperative complications, operation time, intraoperative blood loss, and number of dissected lymph nodes were compared between each two groups.
The incidence of postoperative complications of BMI-L and BMI-H groups was 11.3% and 30%, respectively (p = 0.18). The mean blood loss was 85 and 134 g, respectively (p = 0.21). There were no significant differences in operation time and the number of retrieved LNs. The incidence postoperative complications (29%) and mean blood loss (148 g) of then VFA-H group were significantly higher than those of the VFA-L group (5.7%, 48 g). The number of retrieved LNs of the VFA-H group (n = 25) was significantly lower than that of the VFA-L group (n = 34). There was no significant difference in operation time.
In the VFA-H group, the incidence of postoperative complications and intraoperative blood loss increased, and the dissected number of LNs decreased. The area of visceral fat tissue was useful to predict risks of LAG and postoperative complications with higher precision compared with BMI.
采用 3D-CT 对胃周血管进行术前评估，并对手术进行标准化后，肥胖仍然会影响腹腔镜辅助胃癌根治术（LAG）的顺利进行。我们评估了体重指数（BMI）和内脏脂肪组织面积对 LAG 风险的影响。
纳入 66 例行 LAG 治疗的胃癌患者。根据 BMI（<25 BMI-L 组：n = 53；≥25 BMI-H 组：n = 13）和腹腔内脂肪组织面积（<100 cm²AF-L 组：n = 35；≥100 cm²AF-H 组：n = 31）将患者分为两组。使用腹部 CT 计算机软件进行脂肪扫描（®），测量内脏脂肪面积（VFA）。比较两组间术后并发症发生率、手术时间、术中出血量和淋巴结清扫数量。
BMI-L 组和 BMI-H 组的术后并发症发生率分别为 11.3%和 30%（p = 0.18）。平均出血量分别为 85 和 134 g（p = 0.21）。手术时间和淋巴结清扫数量无显著差异。VFA-H 组术后并发症发生率（29%）和平均出血量（148 g）明显高于 VFA-L 组（5.7%，48 g）。VFA-H 组淋巴结清扫数量（n = 25）明显少于 VFA-L 组（n = 34）。手术时间无显著差异。
在 VFA-H 组中，术后并发症发生率和术中出血量增加，淋巴结清扫数量减少。与 BMI 相比，内脏脂肪组织面积能更精确地预测 LAG 和术后并发症的风险。
