Influence of excess body weight on the surgical outcomes of total gastrectomy

Purpose: We conducted this retrospective study to identify the influence of excess body weight on the surgical outcome of total gastrectomy (TG) and to evaluate recent advances in this operation. Methods: The subjects were 644 consecutive gastric cancer patients who underwent TG between 1992 and 2008. Patients with a body mass index (BMI) of 25.0 kg/m ² or greater were defined as overweight (overweight group) and those with a BMI less than 25.0 kg/m ² as not overweight (non-overweight group). Results: The operating times were longer (P = 0.005) and intraoperative blood loss was greater (P < 0.001) in the overweight group. The incidence of overall postoperative complications (P = 0.012) and of pancreatic fistula (P < 0.001) were significantly higher in the overweight group. In recent years, we achieved a reduction in operating time (P < 0.001), intraoperative blood loss (P = 0.033), and incidence of pancreatic fistula (P = 0.005), while maintaining curability, in the overweight group. Conclusions: Although TG for gastric cancer is technically more difficult in overweight patients, they should not be denied this operation. Conversely, we should make a greater effort to improve the surgical outcomes of overweight patients.