Effect Of Visceral Obesity On Short-term Outcome Of Laparoscopic Radical Gastrectomy For Patients With Gastric Cancer

BackgroundObesity is recognized as a risk factor for postoperative complications of the digestive tract surgery.Currently,the body mass index(BMI)is the most frequently used index for evaluating obesity,but it cannot reflect the severity of obesity accurately.At present,some literatures indicate that the visceral fat area(VFA)is related to poor prognosis of digestive tract surgery.However,there are few studies on the effects of VFA on short-term outcomes after laparoscopic radical gastrectomy.This study is aimed at evaluating the ability of VFA to predict the short-term complications after laparoscopic radical gastrectomy for gastric cancer and is designed to probe into the clinical value of VFA.MethodThis study collects the clinical data of 180 eligible patients undergoing laparoscopic radical gastrectomy(LRG)from January 2015 to June 2017 at our Hospital.Using VFA as the obesity index,180 cases are divided into the visceral obesity group(N=43)and the non-visceral obesity group(N=137).Firstly,the general data such as age,gender and tumor stage are compared.Secondly,by grouping patients with two different obesity index(VFA and BMI),this study compares the major postoperative complications(including anastomotic leakage,anastomotic bleeding,anastomotic obstruction,pulmonary infection,intra-abdominal abscess and surgical site infection),the number of lymph nodes and the average hospital stay.Thirdly,according to the incidence of anastomotic leakage(AL)after operations,the patients are divided into the anastomotic leakage group(N=12)and the non-anastomotic leakage group(N=168).The age,gender,BMI,SFA(Subcutaneous fat area),VFA,the intraoperative conditions(including the duration of operation,intraoperative blood loss and blood transfusion)of the two groups are compared by univariate analysis.Fourthly,the study uses multivariable analysis to analyze factors with significant differences through logistic regression.Last,the study uses the same technique to analyze the risk factors of surgical site infection and postoperative pulmonary infection.ResultBy comparing the basic data of patients in the visceral obesity group(N=43)and the non-visceral obesity group(N=137),the study finds there are statistically significant differences in BMI(P<0.001),SFA(P<0.001),TFA(P<0.001)and in whether there is diabetes(P=0.005)between two groups.Through the comparison of the short-term outcomes after laparoscopic radical gastrectomy between high VFA group and low VFA group,this study shows that there are statistically significant differences in postoperative anastomotic leakage(P=0.029),the duration of operation(P=0.002),surgical site infection(P<0.001),and intraoperative blood loss(P=0.025).By comparing the short-term outcomes after laparoscopic radical gastrectomy between high BMI group and low BMI group,this study indicates that there is no significant difference between the two groups in terms of anastomotic leakage,surgical site infection,and pulmonary infection.By comparing the patients with anastomotic leakage(N=12)and the patients without anastomotic leakage(N=168),this study figures that the differences in VFA and intraoperative blood loss between the two groups are statistically significant.Multivariate analysis shows that VFA is an independent risk factor for anastomotic leakage after laparoscopic radical gastrectomy(P=0.012).By comparing patients with or without surgical site infection,it points out that there is a statistically significant difference in VFA(P<0.001),SFA(P=0.028),and blood loss(P=0.041)between the two groups.Besides,multivariate analysis reveals that VFA is an independent risk factor for postoperative surgical site infection(P=0.021).By comparing patients with or without pulmonary infection,the study discovers that postoperative nasogastric intubation(over 6 days)(P=0.049),intraoperative blood transfusion(P=0.03),smoking history(P=0.013),medical history of chronic bronchitis / COPD(P=0.037)and intraoperative blood loss(P=0.048)are significantly different between the two groups.Conclusion(1)the risk of anastomotic leakage and surgical site infection after laparoscopic radical gastrectomy for high VFA patients is increased,and significantly increases the incidence of anastomotic leakage and surgical site infection,and is more advantageous than BMI in predicting adverse outcomes.(2)there was no obvious correlation between pulmonary infection and VFA after operation,but it was related to the time of lien stomach tube,lung basic disease,blood transfusion or not.