Impact Of Body Mass Index On The Security Of Laparoscopic D2 Radical Gastrectomy In Asian Patients:A Meta-analysis

Objective: Gastric cancer(GC),the second most prevalent cause of cancer-related deaths worldwide,has been a source of increasing concern.Laparoscopic radical gastrectmoy(LRG)has become increasingly popular for treating early GC due to decreased intraoperative blood loss,less pain,and shorter hospital duration.With the development of experience of surgeons,Laparoscopic D2 radical gastrectomy has been performed widely in Asian area.The prevalence of obesity is increasing steadily in Asian countries.To date,although several studies used body mass index(BMI)to assess the impact of obesity on the security of laparoscopic D2 radical gastrectomy,the results have been controversial and limited.Hence,we conducted this meta-analysis to summarize all of the available evidence.Methods: The PubMed,Cochrane,EMBASE,and Web of Science databases were searched for studies that focused on the impacts of obesity on the security of laparoscopic D2 radical gastrectomy for GC in Asian patients who were classified into the high BMI(BMI ? 25 kg/m2)or low BMI group(BMI < 25 kg/m2).The results are expressed using the pooled odds ratio(OR)for binary variables and standard mean differences(SMDs)for continuous variables with 95% confidence intervals(CIs)and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.Results: Nine studies,with a total sample size of 6077,were included in this meta-analysis.Compared with the low BMI group,the high BMI group had longer operative times(SMD = 0.26,95%CI: 0.21 to 0.32,P < 0.001),greater blood loss(SMD = 0.19,95%CI: 0.12 to 0.25,P < 0.001)and fewer retrieved lymph nodes(SMD =-0.13,95%CI: 0.18 to 0.07,P < 0.001).There were no significant differences between the high and low BMI groups in postoperative complications(OR = 1.12,95%CI: 0.95 to 1.33,P = 0.169),the duration of postoperative hospital stay(SMD = 0.681,95%CI:-0.05 to 0.07,P = 0.681),postoperative mortality(OR = 1.95,95%CI: 0.78 to 4.89,P = 0.153)and time to starting diet(SMD = 0.00,95%CI:-0.06 to 0.06,P = 0.973).Conclusion: Our meta-analysis provides strong evidence that despite the longer operative time,greater blood loss and fewer retrieved lymph nodes,the association between BMI and the short-term ourcomes after laparoscopic D2 radical gastrectomy including postoperative complications,the duration of postoperative hospital stay,postoperative mortality and time to starting to diet after laparoscopic D2 radical gastrectomy for GC in Asian patients were not significant.BMI could be a poor risk factor for short-term worse outcomes after laparoscopic D2 radical gastrectomy.Other indices should be taken into account.