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Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer
Stephan Gretschel1, Frank Christoph, Andreas Bembenek
1Department of Surgery and Surgical Oncology, Humboldt University, Charité, Campus Berlin Buch, Robert-Rössle Hospital, HELIOS Klinikum, Berlin, Germany.
Background:
The extent of standard lymph node dissection (D1, D2, or D3) in gastric cancer patients is still controversial. Several prospective European trials attained contradictory results. A generally increased body mass index (BMI) of the European patients was assumed to be one of the major causes for postoperative morbidity.
Methods:
We evaluated the effect of BMI on the quality of routine D2 lymph node dissection and on postoperative morbidity in patients with gastric cancer who underwent a potentially curative total gastrectomy. A total of 199 consecutive gastric cancer patients who underwent a total gastrectomy and a routine D2 lymph node dissection between 1992 and 2001 were included in the study. According to BMI, they were assigned to three groups: group A, with BMI <25 kg/m(2) (normal body weight); group B, with BMI of 25 to 30 kg/m(2) (overweight); and group C, with BMI >30 kg/m(2) (obesity). Parameters such as complete histopathological staging, intraoperative blood loss, length of operation, and surgical and nonsurgical morbidity were recorded and correlated within the different groups.
Results:
No significant differences were found with regard to the number of examined lymph nodes, blood loss, length of operation, surgical complications, or length of stay in the intensive care unit.
Conclusions:
In contrast to comparable Japanese studies, our analysis reveals that even for overweight patients, a standard D2 lymph node dissection is justified without significantly increased morbidity.