the effect of obesity on the radicality of subtotal oesophagectomy for oesophageal adenocarcinoma s...
TRANSCRIPT
The Effect of Obesity on the Radicality of Subtotal Oesophagectomy for
Oesophageal Adenocarcinoma
S Wahed, HV Jones, A Krishnan, J Shenfine, SM Griffin
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary,
Newcastle Upon Tyne
BMI Distribution in English Men 1993-2010
Health Surveys for England, 2010
Obesity as a Risk Factor
1. Association between Body Mass Index and adenocarcinoma of the esophagus and gastric cardia, Lagergren et al, Ann Intern Med, 1999;130:883-90
2. Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus, Whiteman et al, Gut, 2008: 57:173-180
3. Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study, Merry et al, Gut 2011:56 1503-1511
Oesophagectomy in the Obese
Author,Year
N Histology
Average Lymph Node Yield
Complications5 Year
Survival (p value)
Scarpa 2012
278 Mixed Not stated
Reduced respiratory complications in obese
Similar0.05
Blom 2012
736 Mixed 18 -19
Increased anastomotic leak in obesity
Similar 0.517
Melis 2011
490 Mixed 8.5 -9.2 Overall similar Increased0.01
Madani2010
142 Adenocarcinoma only
13 Increased respiratory complications in obesity
Increased 0.008
Grotenhuis 2010
556 Mixed 9-12 Increased anastomotic leak and severe
complications in obesity
Similar0.25
Healy 2007
150 Adenocarcinoma only
10-15 Increased respiratory complications and
anastomotic leak in obesity
Similar 0.348
Morgan2007
215 Mixed 11-14 Increased wound infections in obesity
Similar0.689
Aims1. Evaluate the changing trends of obesity in patients
with adenocarcinoma undergoing subtotal
oesophagectomy in the North East of England
2. Evaluate the effect of obesity on radical
lymphadenectomy
3. Evaluate the effect of obesity on post-operative
complications
4. Evaluate the effect of obesity on long-term survival
Methods• NOGCU prospective database: Jan 2000 – Dec
2010
• Two phase subtotal oesophagectomy with radical 2 field lymphadenectomy only
• Oesophageal adenocarcinoma only
• WHO BMI criteria– Underweight <18.5kg/m2
– Normal 18.5kg/m2 - 24.99kg/m2
– Overweight 25kg/m2 - 29.99kg/m2
– Obese ≥30kg/m2
23 No BMI recorded
14 Other operative approach
170 Other histology
Median BMI 27.2Median BMI 26.0
Body Mass Index Distribution with Time
p = 0.065
Number of Patients per BMI Category
International Society for Diseases of the Esophagus, Venice, 2012
Demographic
Normal Weight
Overweight
Obese p value
% Male 85 84 83 0.946Median Age 66 66 60 <0.001
Demographic
Normal Weight
Overweight
Obese p value
% Male 85 84 83 0.946Median Age 66 66 60 <0.001
p = 0.041
Perc
enta
ge w
ith
dis
ease
Barrett’s Oesophagus
Demographic
Normal Weight
Overweight
Obese p value
% Male 85 84 83 0.946Median Age 66 66 60 <0.001
p = 0.041 p = 0.650
Perc
enta
ge w
ith
dis
ease
Barrett’s Oesophagus Reflux Disease
Perioperative Outcome
Normal Weight
Overweight
Obese p value
Median Op Time / min 368 370 390 0.052
R0 Resection rate / %
97 94 96 0.604
Median Number Lymph Nodes
34 30 33 0.178
Lymph Node Ratio / %
0.05 0.02 0 0.108
Lymph Node Negative / %
37 49 56 0.020
Stage Normal Weight
Overweight Obese*
0 2 (2%) 4 (2%) 1 (1%)
1 18 (16%) 45 (27%) 30 (32%)
2a 22 (19%) 33 (20%) 21 (23%)
2b 14 (12%) 21 (13%) 10 (11%)
3 57 (49%) 64 (38%) 30 (32%)
4 3 (3%) 1 (1%) 1 (1%)
*compared to normal p = 0.040
Complication
Normal Weight
Overweight
ObeseOvera
ll
p valu
e
All / % 65.5 61.3 66.7 63.90.58
5
Respiratory / %
23.3 26.2 35.5 27.60.12
6
Wound / % 13.8 14.9 19.4 15.60.51
0
Chyle Leak / %
11.2 5.4 4.3 6.90.08
4
Anastomotic Leak / %
7.8 6.5 7.5 7.20.91
6
In-Hospital Mortality / %
4.3 2.4 1.1 2.70.33
6
Overall Survival
Log rank,p = 0.003
Conclusions1. Median BMI has increased with time
2. Obese patients have equally radical lymphadenectomy as
normal weight patients
3. Wound and respiratory complications are more common in
obese patients but overall complication rate is similar between
groups
4. Overall and disease-free survivals are not significantly different
between BMI groups, once patients are stage matched
Acknowledgements
Helen Jaretzke Database Manager
NOGCU
Angela Tait Database Clerk NOGCU
The Effect of Obesity on the Radicality of Subtotal Oesophagectomy for
Oesophageal Adenocarcinoma
S Wahed, HV Jones, A Krishnan, J Shenfine, SM Griffin
Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary,
Newcastle Upon Tyne, UK