内脏脂肪面积（VFA）优于 BMI 预测根治性胃切除术后术后并发症：一项前瞻性队列研究。
Visceral Fat Area (VFA) Superior to BMI for Predicting Postoperative Complications After Radical Gastrectomy: a Prospective Cohort Study.
机构信息
Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu, Sichuan Province, China.
West China School of Medicine, Sichuan University, Chengdu, China.
出版信息
J Gastrointest Surg. 2020 Jun;24(6):1298-1306. doi: 10.1007/s11605-019-04259-0. Epub 2019 Jun 3.
BACKGROUND
Obesity may impact surgical outcomes of gastrectomy. Whether visceral fat area (VFA) is a better obesity parameter than body mass index (BMI) is still controversial. The aim of this study is to compare the accuracy and effectiveness of VFA and BMI in predicting the short-term surgical outcomes of gastrectomy.
METHODS
Patients who were diagnosed with gastric cancer were measured for BMI and VFA preoperatively and then divided into a VFA-H (VFA-high) group and VFA-L (VFA-low) group, at the cutoff point of 100 cm, and a BMI-H (BMI-high) group and BMI-L (BMI-low) group, at the cutoff point of 25 kg/m. The short-term surgical outcomes were compared between the different groups.
RESULTS
In total, 276 patients were enrolled in this study; 55 (19.9%) patients were classified into the BMI-H group, and 122 (44.2%) patients were classified into the VFA-H group. There was a significant correlation between BMI and VFA (r = 0.652, p < 0.001). Compared with the VFA-L group, the VFA-H group had a higher incidence of postoperative complications (31.1% vs. 13.0%; p < 0.001), longer operation duration (270.0 (235.0-305.0) vs. 255.0 (223.8-295.0), p = 0.046), and more blood loss (100.0 (100.0-150.0) vs. 80.0 (80.0-100.0), p < 0.001), while the BMI-H group had more blood loss than the BMI-L group (100.0 (100.0-120.0) vs. 100.0(80.0-100.0), p = 0.006). Logistic regression showed that VFA was an independent risk factor for postoperative complications (odds ratio 2.813, 95% CI 1.523-5.194; p = 0.001).
CONCLUSION
For gastric cancer patients, VFA is superior to BMI in accurately and effectively illuminating the impact of obesity on short-term surgical outcomes.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT02800005.
背景
肥胖可能会影响胃切除术的手术结果。内脏脂肪面积（VFA）是否比体重指数（BMI）更能反映肥胖，目前仍存在争议。本研究旨在比较 VFA 和 BMI 预测胃切除术短期手术结果的准确性和有效性。
方法
术前对诊断为胃癌的患者进行 BMI 和 VFA 测量，然后根据 VFA 截断值 100 cm 分为 VFA 高（VFA-H）组和 VFA 低（VFA-L）组，根据 BMI 截断值 25 kg/m 分为 BMI 高（BMI-H）组和 BMI 低（BMI-L）组。比较不同组间的短期手术结果。
结果
共纳入 276 例患者，其中 55 例（19.9%）患者归入 BMI-H 组，122 例（44.2%）患者归入 VFA-H 组。BMI 与 VFA 呈显著正相关（r=0.652，p<0.001）。与 VFA-L 组相比，VFA-H 组术后并发症发生率更高（31.1%比 13.0%；p<0.001），手术时间更长（270.0（235.0-305.0）比 255.0（223.8-295.0），p=0.046），出血量更多（100.0（100.0-150.0）比 80.0（80.0-100.0），p<0.001），而 BMI-H 组的出血量多于 BMI-L 组（100.0（100.0-120.0）比 100.0（80.0-100.0），p=0.006）。Logistic 回归显示，VFA 是术后并发症的独立危险因素（比值比 2.813，95%CI 1.523-5.194；p=0.001）。
结论
对于胃癌患者，VFA 比 BMI 更能准确有效地反映肥胖对短期手术结果的影响。
试验注册
Clinicaltrials.gov：NCT02800005。
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