Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
BMC Surg. 2021 Apr 23;21(1):207. doi: 10.1186/s12893-021-01221-3.
Obesity can affect postoperative outcomes of gastrectomy. Visceral fat area is superior to body mass index in predicting postoperative complications. However, visceral fat area measurement is time-consuming and is not optimum for clinical use. Meanwhile, trunk fat volume (TFV) can be easily measured via bioelectrical impedance analysis. Hence, the current study aimed to determine the ability of TFV to predict the occurrence of complications after gastrectomy.
We retrospectively reviewed patients who underwent curative gastrectomy for gastric cancer between November 2016 and November 2019. The trunk fat volume-to-the ideal amount (%TFV) ratio was obtained using InBody 770 before surgery. The patients were classified into the obese and nonobese groups according to %TFV (TFV-H group, ≥ 150%; TFV-L group, < 150%) and body mass index (BMI-H group, ≥ 25 kg/m; BMI-L group, < 25 kg/m). We compared the short-term postoperative outcomes (e.g., operative time, blood loss volume, number of resected lymph nodes, and duration of hospital stay) between the obese and nonobese patients. Risk factors for complications were assessed using logistic regression analysis.
In total, 232 patients were included in this study. The TFV-H and BMI-H groups had a significantly longer operative time than the TFV-L (p = 0.022) and BMI-L groups (p = 0.006). Moreover, the TFV-H group had a significantly higher complication rate (p = 0.004) and a lower number of resected lymph nodes (p < 0.001) than the TFV-L group. In the univariate analysis, %TFV ≥ 150, total or proximal gastrectomy, and open gastrectomy were found to be potentially associated with higher complication rates (p < 0.1 for all). Moreover, the multivariate analysis revealed that %TFV ≥ 150 (OR: 2.73; 95% CI: 1.37-5.46; p = 0.005) and total or proximal gastrectomy (OR: 3.57; 95% CI: 1.79-7.12; p < 0.001) were independently correlated with postoperative morbidity.
%TFV independently affected postoperative complications. Hence, it may be a useful parameter for the evaluation of obesity and a predictor of complications after gastrectomy.
肥胖会影响胃切除术的术后结果。内脏脂肪面积优于体重指数，可预测术后并发症。然而，内脏脂肪面积的测量耗时且不适用于临床应用。同时，体脂总量（TFV）可以通过生物电阻抗分析轻松测量。因此，本研究旨在确定 TFV 预测胃切除术后并发症发生的能力。
我们回顾性分析了 2016 年 11 月至 2019 年 11 月期间因胃癌接受根治性胃切除术的患者。手术前使用 InBody 770 获得体脂总量与理想量的比值（%TFV）。根据 %TFV（TFV-H 组，≥150%；TFV-L 组，<150%）和体重指数（BMI-H 组，≥25kg/m；BMI-L 组，<25kg/m）将患者分为肥胖组和非肥胖组。我们比较了肥胖和非肥胖患者之间的短期术后结果（例如手术时间、失血量、切除的淋巴结数量和住院时间）。使用逻辑回归分析评估并发症的危险因素。
共有 232 名患者纳入本研究。TFV-H 组和 BMI-H 组的手术时间明显长于 TFV-L 组（p=0.022）和 BMI-L 组（p=0.006）。此外，TFV-H 组的并发症发生率明显较高（p=0.004），切除的淋巴结数量明显较少（p<0.001）。在单因素分析中，%TFV≥150、全胃或近端胃切除术和开放性胃切除术与较高的并发症发生率相关（p<0.1）。此外，多因素分析显示，%TFV≥150（OR：2.73；95%CI：1.37-5.46；p=0.005）和全胃或近端胃切除术（OR：3.57；95%CI：1.79-7.12；p<0.001）与术后发病率独立相关。
%TFV 独立影响术后并发症。因此，它可能是评估肥胖的有用参数，也是胃切除术后并发症的预测指标。
