体质量指数与腺癌患者食管癌术后围手术期并发症：系统数据库回顾。
Body mass index and perioperative complications after oesophagectomy for adenocarcinoma: a systematic database review.
机构信息
Department of Surgery, New York University Medical School, New York, New York, USA.
出版信息
BMJ Open. 2013 May 2;3(5):e001336. doi: 10.1136/bmjopen-2012-001336.
OBJECTIVE
Given the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after oesophagectomy for adenocarcinoma of the oesophagus.
DESIGN
Retrospective database review.
SETTING
Single institution high volume oncological tertiary care referral centre.
PARTICIPANTS
From our comprehensive oesophageal cancer database consisting of 709 patients, we stratified patients according to BMI: 155 normal-weight (BMI 20-24), 198 overweight (BMI 25-29) and 187 obese (BMI ≥30) patients.
INTERVENTIONS
All patients underwent oesophagectomy for cancer.
PRIMARY AND SECONDARY OUTCOME MEASURES
Incidences of preoperative risk factors and perioperative complications in each group were analysed.
RESULTS
The patient cohort consisted of 474 men and 66 women with a mean age of 64.3 years (28-86). They were similar in terms of demographics and comorbidities, with the exception of a younger age (65.2 vs 65.4 vs 62.5 years, p=0.0094), and a higher incidence of diabetes (9.1% vs 13.2% vs 22.7%, p=0.001), hiatal hernia (16.8% vs 17.8% vs 28.8%, p=0.009) and Barrett oesophagus (24.7% vs 25.4% vs 36.2%, p=0.025) for obese patients. The type of surgery performed, overall blood loss, extent of lymphadenectomy, R0 resections and complications were not influenced by BMI on univariate and multivariate analysis.
CONCLUSIONS
In our experience, patients with an elevated BMI and oesophageal adenocarcinoma do not experience an increase in morbidity and mortality after oesophagectomy as stated in previous reports, when performed at a high volume centre. Additionally, BMI did not affect the quality of oncological resection as determined by number of harvested lymph-nodes and rates of R0 resections.
TRIAL REGISTRATION
MCC 15030, IRB 105286.
目的
鉴于肥胖率的不断上升，超重对手术结果的影响是一个相关的医疗质量关注点。我们的目的是确定术前体重指数（BMI）与食管腺癌患者食管切除术后围手术期并发症之间的关系。
设计
回顾性数据库研究。
设置
单机构大容量肿瘤三级转诊中心。
参与者
从我们的 709 例食管癌综合数据库中，我们根据 BMI 将患者分层：155 例体重正常（BMI 20-24）、198 例超重（BMI 25-29）和 187 例肥胖（BMI≥30）患者。
干预措施
所有患者均因癌症行食管切除术。
主要和次要结果测量
分析每组术前危险因素和围手术期并发症的发生率。
结果
患者队列由 474 名男性和 66 名女性组成，平均年龄为 64.3 岁（28-86 岁）。他们在人口统计学和合并症方面相似，除了年龄较小（65.2 岁比 65.4 岁比 62.5 岁，p=0.0094）、糖尿病发病率较高（9.1%比 13.2%比 22.7%，p=0.001）、食管裂孔疝（16.8%比 17.8%比 28.8%，p=0.009）和巴雷特食管（24.7%比 25.4%比 36.2%，p=0.025）外。单因素和多因素分析显示，手术类型、总失血量、淋巴结清扫程度、R0 切除率和并发症不受 BMI 影响。
结论
根据我们的经验，在大容量中心进行手术时，患有升高的 BMI 和食管腺癌的患者在接受食管切除术后不会像之前的报告所述那样增加发病率和死亡率。此外，BMI 并未影响通过淋巴结采集数量和 R0 切除率确定的肿瘤切除质量。
试验注册
MCC 15030，IRB 105286。
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