Chen Ke, Pan Yu, Zhai Shu-Ting, Cai Jia-Qin, Chen Qi-Long, Chen Ding-Wei, Zhu Yi-Ping, Zhang Yu, Zhang Ya-Ping, Maher Hendi, Wang Xian-Fa
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, 310016, China.
BMC Gastroenterol. 2017 Jun 19;17(1):78. doi: 10.1186/s12876-017-0638-1.
Obesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.
We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients.
A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.
Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.
肥胖在全球范围内呈日益流行趋势，与体重正常的患者相比，肥胖患者通常被视为手术高风险人群。本研究旨在评估肥胖对胃癌腹腔镜胃切除术（LG）手术结局的影响。
我们回顾了2004年10月至2016年12月期间在我院接受LG治疗胃癌的所有患者的数据。将患者分为非肥胖组和肥胖组，并比较围手术期结局。此外，进行了亚组分析，以评估两种常用的LG方法，即腹腔镜辅助胃切除术（LAG）和全腹腔镜胃切除术（TLG），哪种更适合肥胖患者。
在研究期间，共有1691例患者接受了LG，其中1255例为非肥胖患者，436例为肥胖或超重患者。肥胖组的平均手术时间显著长于非肥胖组（209.9±29.7 vs. 227.2±25.7分钟，P<0.01），非肥胖组的术中出血量显著更低（113.4±34.1 vs. 136.9±36.7毫升，P<0.01）。非肥胖组的首次排气时间、开始经口进食时间和术后住院时间显著短于肥胖组（分别为3.3±0.8 vs. 3.6±0.9天；4.3±1.0 vs. 4.6±1.0天；9.0±2.2 vs. 9.6±2.2天；P<0.01）。非肥胖患者中有119例（9.5%）发生术后并发症，而肥胖患者中有44例（10.1%）发生术后并发症（P=0.71）。在所有患者的亚组分析中，与LAG相比，TLG在早期手术结局方面显示出更好的结果，这主要归因于其在肥胖患者中的优势。
肥胖与腹腔镜胃切除术后手术时间长、出血量增加和恢复缓慢有关，但不影响术中安全性或有效性。由于多种原因，TLG对肥胖患者可能产生的负面结果可能比LAG少。我们的分析表明，就早期手术结局而言，TLG对肥胖患者更具优势。
