Preoperative Low Weight Affects Long-term Outcomes Following Curative Gastrectomy for Gastric Cancer

A recent nationwide survey using the National Clinical Database in Japan identified a high proportion of low-weight patients, who are defined as low body mass index (BMI) patients, in comparison with Western countries. This study was designed to investigate the influence of low BMI on short- and long-term outcomes after curative gastrectomy for gastric cancer.

Overall, 1,281 consecutive gastric cancer patients, who underwent curative gastrectomy with radical lymphadenectomy from 1997 through 2012 were retrospectively analyzed. Low BMI and non-low BMI were defined as a BMI<18.5 and BMI>18.5 kg/m², respectively.

Compared to patients with BMI higher than 18.5, those with BMI<18.5 had a significantly shorter duration of surgery (p<0.001) and tended to have lower blood loss (p=0.058). There was no difference in preoperative serum albumin level (p=0.592) and the incidence in postoperative abdominal infection complications (p=0.925) between the two groups. Whereas, BMI<18.5 was significantly associated with female gender, anemia, deeper tumor depth and nodal metastasis. Univariate and multivariate analyses revealed that the BMI<18.5 was an independent poor prognostic factor for overall survival [p=0.010, HR 1.6 (95%CI=1.32-2.30)]. Concerning recurrence, the cumulative incidence rate was significantly higher in patients with BMI<18.5 than those without (p=0.045).

Low weight did not have adverse effects on short-term outcomes including postoperative complications. However, there was a negative prognostic impact of low BMI, suggesting the requirement of meticulous treatments and follow-up in these gastric cancer patients.