Background
Obesity is a substantial public health issue with known links to oesophagogastric cancer. It is believed to increase surgical technical challenges may increase intraoperative challenges and complications. In the last decade, the ClassIntra classification was developed for the standardised reporting of intraoperative adverse events. In this study, we aimed to compare intraoperative complications between BMI groups in patients undergoing surgery for oesophagogastric cancer.
Methods
Retrospective review was undertaken of patients who underwent oesophageal or gastric cancer resection from 1 October 2013 to 31 October 2023. They were compared according to body mass index (BMI) categories of BMI<25 (“normal”), BMI 25-30 (“overweight”) and BMI>30 (“obese”). Outcome measures included rates of intraoperative complications as defined by ClassIntra, length of operation, length of stay, haemoglobin drop, packed red blood cell (PRBC) transfusions, highest Clavien-Dindo classification, 30-day readmission and 30-day mortality.
Results
A total of 272 patients were included (202 gastrectomies and 70 oesophagectomies). There was no significant difference in ClassIntra between the BMI categories in both the gastrectomy and oesophagectomy cohorts (p=0.738 and p=0.342 respectively). Obese oesophagectomy patients had significantly longer operative times (p=0.026). Normal BMI gastrectomy patients had longer lengths of stay (p=0.008) and higher rates of PRBC transfusions (p=0.029), whilst overweight oesophagectomy patients had significantly higher rates of PRBC transfusions (p=0.045) and representations within 30 days (p=0.02).
Conclusions
Surgery for oesophagogastric cancers can be performed safely regardless of BMI although a longer operative time may be required in obese patients.