Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan.
Langenbecks Arch Surg. 2022 May;407(3):999-1008. doi: 10.1007/s00423-021-02369-5. Epub 2021 Nov 6.
This study aimed to evaluate the short- and long-term outcomes in obese patients with gastric cancer undergoing totally laparoscopic total gastrectomy (TLTG) to clarify its feasibility in this population.
We examined 136 consecutive patients who underwent TLTG for gastric cancer (GC) between 2013 and 2018. A total of 45 patients with a body mass index (BMI) ≥ 25 kg/m were defined as the obese group (obese and overweight patients by the WHO classification), and 91 patients with a BMI < 25 kg/m were defined as the non-obese group. Short- and long-term outcomes were compared, and the correlation between obesity and postoperative complications was examined in patients who underwent TLTG.
Although the operation time (min) was significantly longer in the obese group than in the non-obese group (329 vs 307, p = 0.002), there were no significant differences in the total volume of blood loss (mL) (118 vs 60, p = 0.059) or the rate of conversion to laparotomy between the two groups (2 vs 2, p = 0.466). Moreover, there was no significant difference in the incidence of postoperative complications between the two groups (16% vs 19%, p = 0.653). In the multivariate analysis, obesity was not identified as a risk factor for postoperative complications among patients who underwent TLTG. The rate of overall survival was not significantly different between the groups (p = 0.512).
TLTG is feasible for obese Japanese patients with GC. To validate the results of the present study, it is necessary to conduct a prospective study of a large population of patients with GC.
本研究旨在评估肥胖胃癌患者行全腹腔镜全胃切除术（TLTG）的短期和长期结果，以明确其在该人群中的可行性。
我们检查了 2013 年至 2018 年间接受 TLTG 治疗的 136 例连续胃癌（GC）患者。共有 45 例体重指数（BMI）≥25kg/m2的患者被定义为肥胖组（根据世界卫生组织分类，肥胖和超重患者），91 例 BMI<25kg/m2的患者被定义为非肥胖组。比较了短期和长期结果，并检查了 TLTG 患者中肥胖与术后并发症的相关性。
虽然肥胖组的手术时间（分钟）明显长于非肥胖组（329 对 307，p=0.002），但两组总出血量（毫升）（118 对 60，p=0.059）或中转开腹率（2 对 2，p=0.466）均无显著差异。此外，两组术后并发症发生率无显著差异（16%对 19%，p=0.653）。多因素分析显示，肥胖不是 TLTG 患者术后并发症的危险因素。两组总生存率无显著差异（p=0.512）。
TLTG 适用于肥胖的日本 GC 患者。为了验证本研究的结果，有必要对大量 GC 患者进行前瞻性研究。
