Does Obesity Affect Outcomes in Patients Undergoing Esophagectomy for Cancer? A Meta-analysis
Babar Kayani
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorKoji Okabayashi
Department of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
Search for more papers by this authorHutan Ashrafian
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorLeanne Harling
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorChristopher Rao
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorAra Darzi
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorYuko Kitagawa
Department of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
Search for more papers by this authorThanos Athanasiou
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorCorresponding Author
Emmanouil Zacharakis
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
[email protected]Search for more papers by this authorBabar Kayani
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorKoji Okabayashi
Department of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
Search for more papers by this authorHutan Ashrafian
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorLeanne Harling
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorChristopher Rao
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorAra Darzi
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorYuko Kitagawa
Department of Surgery, Graduate School of Medicine, Keio University, Tokyo, Japan
Search for more papers by this authorThanos Athanasiou
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
Search for more papers by this authorCorresponding Author
Emmanouil Zacharakis
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
[email protected]Search for more papers by this authorAbstract
Background
The incidence of esophageal carcinoma and the global prevalence of obesity are both increasing. As a result, there is an increased number of esophagectomies being performed on obese patients. The identification of specific complications in obese patients undergoing esophagectomy may allow improved risk assessment and postoperative management to reduce morbidity and mortality. This meta-analysis aimed to determine whether obese patients are at increased risk of postoperative complications, mortality, and compromised survival compared to non-obese patients following esophageal resection.
Methods
A Medline, Embase, Ovid, and Cochrane database search was performed on all articles between January 1980 and January 2012 comparing post-esophagectomy outcomes between obese and non-obese patients. This study was conducted in accordance with the recommendations of the Cochrane Collaboration and the Quality of Reporting of Meta-Analyses guidelines.
Results
There was no significant difference between obese and non-obese patients with respect to extent of tumor resection, cardiorespiratory complications, anastomotic leakage, reoperation rates, wound infection, or postoperative mortality. Meta-regression analysis showed that diabetes in obese patients was associated with a significant impact on the risk of anastomotic leakage (coefficient = −7.94 [−15.24–0.65, P = 0.03) and atrial fibrillation (coefficient = −6.94 [−12.79–1.10], P = 0.02). Overall, obese patients had significantly better long-term survival than non-obese patients (Hazard Ratio = 0.78 [0.64–0.96], P = 0.02).
Conclusions
In patients who are eligible for surgery, obesity alone does not increase risk of postoperative complications or mortality and should not be an independent contraindication for esophagectomy. However, the presence of diabetes mellitus in conjunction with obesity may be associated with increased risk of anastomotic leakage and atrial fibrillation. Because of the adverse physiological remodeling in obesity, surgeons should maintain a low threshold for the investigation and management of complications and ensure meticulous management of co-morbidities. Obesity may also improve long-term postoperative survival after esophageal surgery, although further studies with higher levels of evidence are necessary to fully determine any advantageous effects of obesity following oncological esophageal surgery.
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