The Effect of Obesity on the Radicality of Subtotal Oesophagectomy for Oesophageal Adenocarcinoma S...

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