Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 985-994
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.985
Impact of body mass index on short-term outcomes of laparoscopic gastrectomy in Asian patients: A meta-analysis
Heng-Kai Chen, Guang-Wei Zhu, Yong-Jian Huang, Wei Zheng, Shu-Gang Yang, Jian-Xin Ye
Heng-Kai Chen, Guang-Wei Zhu, Yong-Jian Huang, Wei Zheng, Shu-Gang Yang, Jian-Xin Ye, Department of Gastrointestinal Surgery 2 Section, the First Hospital Affiliated to Fujian Medical University, Fuzhou 350005, Fujian Province, China
Heng-Kai Chen, Guang-Wei Zhu, Yong-Jian Huang, Wei Zheng, Shu-Gang Yang, Jian-Xin Ye, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Author contributions: Chen HK, Zhu GW, Huang YJ, Zheng W, and Yang SG designed this work, collected and interpreted the data, and drafted the manuscript; Ye JX designed this work, critically revised the manuscript, and performed overall supervision; all authors contributed to the final approval and accountability for the manuscript.
Supported by the Project of Science and Technology Research Program of Fujian Province, No. 2016B044; the Fujian Provincial Natural Science Foundation, No. 2017J01279; the Nursery Garden Scientific Research Fund of Fujian Medical University, No. 2015MP024; Startup Fund for Scientific Research, Fujian Medical University, the Fujian Provincial Health Department Youth Foundation Project, No. 2017-1-51; and the National Clinical Key Specialty Construction Project (General Surgery) of China.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Xin Ye, MD, Professor, Department of Gastrointestinal Surgery 2 Section, the First Hospital Affiliated to Fujian Medical University, No. 20, Chazhong Road, Fuzhou 350005, Fujian Province, China. yejianxinfuyi@126.com
Telephone: +86-591-87982080
Received: September 12, 2018
Peer-review started: September 12, 2018
First decision: October 15, 2018
Revised: October 24, 2018
Accepted: November 1, 2018
Article in press: November 1, 2018
Published online: December 6, 2018
Processing time: 85 Days and 21.2 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is the second most prevalent cause of cancer-related deaths worldwide. Since 1994, laparoscopic gastrectomy (LG) has become increasingly popular for treating early GC in patients. The prevalence of obesity is increasing steadily in Asian countries. Obesity is regarded as a risk factor for worse surgical outcomes of complicated surgical procedures. Furthermore, patients with obesity have a higher risk of operative difficulties, as well as wound infection.

Research motivation

Recently, the impact of obesity on the short-term LG in patients has been controversial due to several studies. For instance, some studies reported that the association between obesity and LG was significant, while others reported the opposite conclusion.

Research objectives

To date, although several studies evaluating the body mass index (BMI) as an index to assess obesity and short-term outcomes of LG, the results have been controversial and limited. Hence, we conducted this meta-analysis to summarize all of the available evidence.

Research methods

The PubMed, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a 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 difference (SMD) for continuous variables with 95% confidence interval (CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.

Research 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 time (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 was no significant difference 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), or time to resuming food intake (SMD = 0.00, 95%CI: -0.06 to 0.06, P = 0.973).

Research conclusions

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 outcomes of laparoscopic gastrectomy for GC, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake was not significant. BMI could be a poor risk factor for short-term outcomes of LG. Other indices should be taken into account.