Pre-operative Weight Loss Program for Obese Patients Undergoing Laparoscopic Gastrectomy

Area of Science:

• Surgical Oncology
• Bariatric Medicine
• Gastroenterology

Background:

• Obesity is a growing concern in patients undergoing surgery for gastric cancer.
• Higher body mass index (BMI) is associated with increased surgical risks and complications.
• The efficacy of pre-operative weight loss programs (PWLP) in this patient group requires further investigation.

Purpose of the Study:

• To evaluate the impact of obesity on laparoscopic gastrectomy (LG) outcomes for gastric cancer (GC).
• To assess the effectiveness of a pre-operative weight loss program (PWLP) for obese patients undergoing LG.

Main Methods:

• Study 1: Compared outcomes of 219 patients undergoing laparoscopic distal gastrectomy (LDG) for GC, divided by BMI (≥28 kg/m² vs. <28 kg/m²).
• Study 2: Evaluated a PWLP (calorie restriction, exercise) in 8 obese patients (BMI ≥28 kg/m²) planned for LG.
• Assessed changes in weight, visceral fat area (VFA), and skeletal muscle mass, alongside surgical outcomes.

Main Results:

• Obese patients (BMI ≥28 kg/m²) experienced longer operation times, greater blood loss, and more post-operative complications.
• The PWLP group achieved a 4.2% weight loss, with a significant 10.6% reduction in VFA; skeletal muscle mass remained stable.
• Patients in the PWLP group demonstrated shorter operation times, reduced blood loss, and fewer complications compared to obese patients without the program.

Conclusions:

• Obesity is a significant risk factor for adverse outcomes in patients undergoing laparoscopic gastrectomy for gastric cancer.
• A pre-operative weight loss program is a beneficial intervention for obese patients, improving surgical safety and efficacy.
• PWLP effectively reduces visceral fat, potentially mitigating surgical risks without compromising muscle mass.