Introduction Obesity is on the increase in the UK and is a known risk factor for adenocarcinoma of the oesophagus. It is recognised that oesophagectomy in obese patients is more difficult with concerns that radicality of resection is reduced. The aims of this study were to evaluate body mass index (BMI) in patients with oesophageal adenocarcinoma who underwent subtotal oesophagectomy with radical lymphadenectomy and to evaluate the effect of obesity on lymph node (LN) dissection and survival.
Methods All patients who underwent subtotal oesophagectomy for adenocarcinoma between January 2000 and December 2010 were identified from a prospectively maintained database. All other histological types were excluded. Patients were categorised according to BMI using the WHO criteria: underweight (2), normal (18.5–24.99 kg/m2), overweight (25-29.99 kg/m2) and obese (≥30 kg/m2). Demographics, presence of Barrett's oesophagus or reflux disease, operative time, R0 resections, complications, LN resection and positivity were analysed. Long-term and disease free survival were calculated using the Kaplan–Meier method.
Results 413 patients were identified. 23 had no BMI recorded and were excluded leaving 390 patients: eight underweight; 117 normal BMI; 172 overweight; 93 obese. BMI significantly increased over time (mean BMI 26.0 in 2000–2001, 27.8 in 2010, p=0.041). Obese patients were younger compared to normal BMI patients (mean age 60.1 and 64.4 respectively, p=0.003). The incidence of Barrett's oesophagus and reflux disease were not significantly different between groups. Operating time was significantly longer for obese patients (p=0.018). R0 resections were similar between groups (normal patients 96.4% and obese 95.5%). The mean number of LNs resected (33 for both normal BMI and obese groups) and the LN ratio did not differ significantly between groups. Obese patients had significantly lower disease stages (32.3% stage 1 obese patients vs 16.2% stage 1 normal BMI patients, p=0.006). Overall survival was longer for obese patients compared with those of normal BMI (81 months vs 55 months, p=0.004). When matched for stage, this difference did not reach significance (p=0.236). Disease free survival did not differ between groups. The overall complication rate was similar between groups (70.1% for normal BMI, 66.3% for obese).
Conclusion This is the first study to evaluate BMI in a homogenous group of patients with adenocarcinoma undergoing subtotal oesophagectomy with a standardised radical lymphadenectomy. BMI and obesity among these patients increased with time. The radicality of surgery, in terms of LN yields and R0 resections, did not reduce in the obesity group and this is further supported by equivalent stage-matched long-term survival.
Competing interests None declared.
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