Association of systemic inflammation and body mass index with survival in patients with resectable gastric or gastroesophageal junction adenocarcinomas

Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer.Methods:A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included.Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio(NLR).High systemic inflammation was defined as NLR≥3,and underweight was defined as BMI<18.5 kg/m2.Results:Among 2,542 patients,NLR≥3 and underweight were common[627(25%)and 349(14%),respectively].In the entire cohort,NLR≥3 or underweight independently predicted overall survival(OS)[hazard ratio(HR):1.236,95%confidence interval(95%CI):1.069–1.430;and HR:1.600,95%CI:1.350–1.897,respectively]and recurrence-free survival(RFS)(HR:1.230,95%CI:1.054–1.434;and HR:1.658,95%CI:1.389–1.979,respectively).Patients with both NLR≥3 and underweight(vs.neither)had much worse OS(HR:2.445,95%CI:1.853–3.225)and RFS(HR:2.405,95%CI:1.802–3.209).Furthermore,we observed similar results in subgroup analyses according to pathological stage,age,and postoperative chemotherapy.Conclusions:Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival.Underweight combined with severe inflammation could enhance prognostication.Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.

Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer

BACKGROUND The association between body mass index(BMI)and clinical outcomes remains unclear among patients with resectable gastric cancer.AIM To investigate the relationship between BMI and long-term survival of gastric cancer patients.METHODS This retrospective study included 2526 patients who underwent radical gastrectomy for gastric cancer between September 2013 and June 2018.The patients were divided into four groups:Group A(low BMI,<18.5 kg/m2),group B(normal BMI,18.5-24.9 kg/m2),group C(overweight,25-29.9 kg/m2),and group D(obese,≥30 kg/m2).Clinicopathological findings and survival outcomes were recorded and analyzed.RESULTS Preoperative weight loss was more common in the low-BMI group,while diabetes was more common in the obese group.Upper-third gastric cancer accounted for a large proportion of cases in the higher BMI groups.Major perioperative complications tended to increase with BMI.The 5-year overall survival rates were 66.4%for group A,75.0%for group B,77.1%for group C,and 78.6%for group D.The 5-year overall survival rate was significantly lower in group A than in group C(P=0.008)or group D(P=0.031).Relative to a normal BMI value,a BMI of<18.5 kg/m^(2)was associated with poor survival(hazard ratio:1.558,95%confidence interval:1.125-2.158,P=0.008).CONCLUSION Low BMI,but not high BMI,independently predicted poor survival in patients with resectable gastric cancer.

Decreased Gastric Body Mucosa Obestatin Expression in Abdominal Obesity Patients With Normal Body Mass Index

The aim of the study was to investigate whether the expression of obestatin in gastric body mucosa in abdominal obesity patients with normal body mass index （BMI） is different compared with healthy controls. Twenty abdominal obesity patients with normal BMI and twenty healthy controls were included in the study. The number of obestatin-positive cells in gastric body mucosa was significantly lower in abdominal obesity patients with normal BMI than that in healthy subjects.

Impact of body mass index on short-term outcomes of laparoscopic gastrectomy in Asian patients: A meta-analysis

AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a high BMI(BMI ≥ 25 kg/m^2) or low BMI group(BMI < 25 kg/m^2). The results are expressed using the pooled odds ratio(OR) for binary variables and standard mean difference(SMD) for continuous variables with 95%confidence interval(CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.RESULTS Nine studies, with a total sample size of 6077, were included in this meta-analysis. Compared with the low BMI group, the high BMI group had longer operative time(SMD = 0.26, 95%CI: 0.21 to 0.32, P < 0.001), greater blood loss(SMD = 0.19, 95%CI: 0.12 to 0.25, P < 0.001), and fewer retrieved lymph nodes(SMD =-0.13, 95%CI: 0.18 to 0.07, P < 0.001). There was no significant difference between the high and low BMI groups in postoperative complications(OR = 1.12, 95%CI: 0.95 to 1.33, P = 0.169), the duration of postoperative hospital stay(SMD = 0.681, 95%CI:-0.05 to 0.07, P = 0.681), postoperative mortality(OR = 1.95, 95%CI: 0.78 to 4.89, P = 0.153), or time to resuming food intake(SMD = 0.00, 95%CI:-0.06 to 0.06, P = 0.973).CONCLUSION Our meta-analysis provides strong evidence that despite being associated with longer operative time, greater blood loss, and fewer retrieved lymph nodes, BMI has no significant impact on the short-term outcomes of LG for GC in Asian patients, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake. BMI may be a poor risk factor for shortterm outcomes of LG. Other indices should be taken into account.

Postoperative body weight change and its influencing factors in patients with gastric cancer

BACKGROUND The high incidence and mortality of gastric cancer(GC)pose a significant threat to human life and health,and it has become an important public health challenge in China.Body weight loss is a common complication after surgical treatment in patients with GC and is associated with poor prognosis and GC recurrence.However,current attention to postoperative weight change in GC patients remains insufficient,and the descriptions of postoperative weight change and its influencing factors are also different.AIM To investigate body weight changes in patients with GC within 6 mo after gastrectomy and identify factors that influence dynamic body weight changes.METHODS We conducted a prospective longitudinal study of 121 patients with GC and collected data before(T0)and 1(T1),3(T2),and 6(T3)mo after gastrectomy using a general data questionnaire,psychological distress thermometer,and body weight measurements.The general estimation equation(GEE)was used to analyze the dynamic trends of body weight changes and factors that influence body weight changes in patients with GC within 6 mo of gastrectomy.RESULTS The median weight loss at T1,T2,and T3 was 7.29%(2.84%,9.40%),11.11%(7.64%,14.91%),and 14.75%(8.80%,19.84%),respectively.The GEE results showed that preoperative body mass index(BMI),significant psychological distress,religious beliefs,and sex were risk factors for weight loss in patients with GC within 6 mo after gastrectomy(P<0.05).Compared with preoperative low-weight patients,preoperative obese patients were more likely to have weight loss(β=14.685,P<0.001).Furthermore,patients with significant psychological distress were more likely to lose weight than those without(β=2.490,P<0.001),and religious patients were less likely to lose weight 6 mo after gastrectomy than those without religious beliefs(β=-6.844,P=0.001).Compared to female patients,male patients were more likely to experience weight loss 6 mo after gastrectomy(β=4.262,P=0.038).CONCLUSION Male patients with GC with high preoperative BMI,significant psychological distress,and no religious beliefs are more likely to lose weight after gastrectomy.

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m^2:a multi-institutional study

Roux-en-Y gastric bypass surgery（RYGB） has been demonstrated to be successful for treating type-II diabetes2mellitus（T2DM） patients with a body mass index（BMI）,30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission（defined by fasting blood glucose（FBG） level,110 mg/d L and hemoglobin（Hb）A1c level,6.0% at 12 months postoperatively）.Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m（P,0.001）.Fifty-eight（67.4%） patients were not treated by drugs or insulin after surgery,and 20 patients（23.3%） had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.

Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis

AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer. METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m 2 ] or overweight (BMI ≥ 25 kg/m 2 ). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software. RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m 2 ; 4897 with BMI ≥ 25 kg/m 2 ). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay. CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.

Risk factors for tuberculosis after gastrectomy in gastric cancer

AIM: To examine incidence of tuberculosis(TB) in gastrectomy patients and investigate the risk factors for developing TB after gastrectomy in patients with gastric cancer.METHODS: A retrospective cohort study of gastrectomy patients with gastric cancer was performed at a university-affiliated hospital in Seoul, South Korea between January 2007 and December 2009. We reviewed patient medical records and collected data associated with the risk of TB, surgery, and gastric cancer. Standardized incidence ratios(SIRs) of TB were calculated to compare the incidence of TB in gastrectomy patients with that in the general Korean population, and risk factors for TB after gastrectomies were analyzed.RESULTS: Among the 1776 gastrectomy patients, 0.9%(16/1776) developed post-gastrectomy TB, with an incidence of 223.7 cases per 100000 patients per year. The overall incidence of TB in gastrectomy patients, adjusted by sex and age, was significantly higher thanthat in the general population(SIR = 2.22, 95%CI: 1.27-3.60). Previous TB infection [odds ratio(OR) = 7.1, P < 0.001], lower body mass index(BMI)(kg/m2; OR = 1.21, P = 0.043) and gastrectomy extent(total gastrectomy vs subtotal gastrectomy)(OR = 3.48, P = 0.017) were significant risk factors for TB after gastrectomy in a multivariate analysis.CONCLUSION: TB incidence after gastrectomy is higher than that in the general population. Previous TB infection, lower BMI, and total gastrectomy are risk factors for TB after gastrectomy in patients with gastric cancer.

Prospective study of the effect of ERAS on postoperative recovery and complications in patients with gastric cancer

Objective:To study the efficacy of the enhanced recovery after surgery(ERAS)program on postoperative recovery and complications in patients with gastric cancer.Methods:Eighty patients in the perioperative period with radical gastrectomy were enrolled and randomly divided into 2 groups,the ERAS group and the non-ERAS group.The differences between the 2 groups in terms of postoperative recoveries and complications rate were determined.According to the body mass index(BMI)level,the ERAS group was divided into 2 subgroups,namely group A(BMI<28 kg/m2,n=16)and group B(BMI≥28 kg/m2,n=24).The non-ERAS group was also divided into group C(BMI<28 kg/m2,n=18)and group D(BMI≥28 kg/m2,n=22).The recovery and complications of each group were then determined.Results:The postoperative length of stay and visual analogue scale pain score were less in the ERAS group than the non-ERAS group(P<0.05).Time to first postoperative exhaustion,first postoperative defecation,returning leukocyte count to normal,and stopping intravenous nutrition were significantly shorter in the ERAS group(n=40),compared to the non-ERAS group(n=40,all P<0.05).The incidence of postoperative lower extremity intramuscular venous thrombosis was significantly higher in group D than in group B(χ2=4.800,P=0.028).In addition,the incidence of lower extremity intermuscular venous thrombosis and lung infection in group D was higher than those in other groups.Conclusions:The perioperative ERAS program was associated with faster recovery in patients undergoing radical gastrectomy.For patients with higher BMI(BMI≥28 kg/m2),the use of the perioperative ERAS program was more advantageous.

Lifestyle factors and long-term survival of gastric cancer patients:A large bidirectional cohort study from China

BACKGROUND Lifestyle factors such as body mass index(BMI),alcohol drinking,and cigarette smoking,are likely to impact the prognosis of gastric cancer,but the evidence has been inconsistent.AIM To investigate the association of lifestyle factors and long-term prognosis of gastric cancer patients in the China National Cancer Center.METHODS Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database 1998-2018.Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models.RESULTS In this study,we reviewed 18441 cases of gastric cancer.Individuals who were overweight or obese were associated with a positive smoking and drinking history(P=0.002 and P<0.001,respectively).Current smokers were more likely to be current alcohol drinkers(61.3%vs 10.1%vs 43.2%for current,never,and former smokers,respectively,P<0.001).Multivariable results indicated that BMI at diagnosis had no significant effect on prognosis.In gastrectomy patients,factors independently associated with poor survival included older age(HR=1.20,95%CI:1.05-1.38,P=0.001),any weight loss(P<0.001),smoking history of more than 30 years(HR=1.14,95%CI:1.04-1.24,P=0.004),and increasing pTNM stage(P<0.001).CONCLUSION In conclusion,our results contribute to a better understanding of lifestyle factors on the overall burden of gastric cancer and long-term prognosis.In these patients,weight loss(both in the 0 to 10%and>10%groups)but not BMI at diagnosis was related to survival outcomes.With regard to other factors,smoking history of more than 30 years conferred a worse prognosis only in patients who underwent gastrectomy.Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyle factors.

经鼻胃管肠内喂养对食管癌患者放化疗期间营养状况及身体状态的影响

目的探讨经鼻留置胃管管饲(NGT)对食管癌患者放化疗期间营养状况及身体状态的影响。方法回顾性分析2020年1月至2023年12月南京医科大学附属宿迁第一人民医院收治的100例行同步放化疗的食管癌患者,按照营养治疗方法不同分为2组,分别接受NGT肠内喂养组(n=50)和口服营养补充(ONS)组(n=50)。比较两组患者干预8周前后的营养状态[营养风险筛查2002(NRS 2002)、患者主观整体评估(PG-SGA)、体质指数(BMI)及相关血清营养指标]、身体状态[Karnofsky功能状态(KPS)评分及放化疗不良反应发生率]。结果干预前两组NRS 2002、PG-SGA和KPS评分比较,差异无统计学意义(P>0.05);干预8周后NGT组NRS 2002及PG-SGA评分明显低于ONS组,而KPS评分明显高于ONS组(P<0.05)。干预前,两组患者血清营养指标水平比较,差异无统计学意义(P>0.05);干预8周后,NGT组血清白蛋白、血红蛋白、铁及前白蛋白水平明显高于ONS组(P<0.05)。两组患者放化疗期间的不良反应发生率比较差异均无统计学意义(P>0.05)。结论对接受放化疗的食管癌患者而言,早期NGT能有效改善患者的营养状况,提高身体状态,临床应用价值良好。

胃黏膜病理学改变、体重指数与血清ghrelin和瘦素关系的研究

目的:探讨血清ghrelin和瘦素水平与胃黏膜病理学改变及体重指数的关系,进一步明确其临床意义。方法:选择2009年4～7月于北京大学第三医院进行胃镜检查的患者156例,于胃镜检查前抽血检测ghrelin和瘦素水平。血清Ghrenlin和瘦素检测采用ELISA法测定。所有患者进行胃镜检查的同时于胃窦和胃体至少分别钳取一块组织进行病理学检查。结果:男性患者血清ghrelin水平低于女性患者(均数250.14ng/Lvs386.65ng/L),两者差异有统计学意义(P=0.003);男性患者血清瘦素水平亦低于女性患者(均数4.12μg/Lvs4.31μg/L),但两者差异无统计学意义(P=0.681)。≤35岁组、36～54岁组和≥55岁组的血清ghrelin均数分别为408.93ng/L、309.16ng/L和236.76ng/L,3组间差异有统计学意义(P=0.007);≤35岁组、36～54岁组和≥55岁组的血清瘦素分别为4.26μg/L、4.41μg/L和3.86μg/L,3组间差异无统计学意义(P=0.549)。慢性浅表性胃炎患者的血清ghrelin水平低于慢性萎缩性胃炎患者(均数308.40ng/Lvs344.88ng/L),两者差异无统计学意义(P=0.870);慢性浅表性胃炎患者血清瘦素水平亦低于慢性萎缩性胃炎患者(均数4.17μg/Lvs4.35μg/L),两者差异无统计学意义(P=0.436)。血清ghrelin水平和BMI存在负相关(P=0.000),血清瘦素水平和BMI存在正相关(P=0.000)。结论:性别和年龄对血清ghrelin水平可能存在影响。慢性浅表性胃炎患者与慢性萎缩性胃炎患者的血清ghrelin和瘦素水平没有差异。随着BMI的增加,血清ghrelin水平降低;而随着BMI的增加,血清瘦素水平亦增加。

胃癌患者血清瘦素与营养状况的关系

目的:探讨肥胖基因表达产物瘦素与胃癌病人营养状况的关系。方法:采用放射免疫分析法测定147例胃癌病人血清瘦素含量,同时测定身高、体重、疾病分期、ECOG法一般状况分级。体质指数(BMI)=体重(kg)/犤身高(m)犦2。营养正常的BMI范围为18.5～25;BMI<18.5为营养不良;BMI>25为肥胖。结果:胃癌病人合并营养不良组的血清瘦素平均含量明显低于营养正常组或肥胖组。男性胃癌病人合并营养不良、营养正常及肥胖组血清瘦素水平分别为(2.41±1.59)μg/L、(4.80±3.21)μg/L、(9.16±2.81)μg/L;女性则分别为(5.53±3.06)μg/L、(8.94±4.78)μg/L、(20.58±9.48)μg/L。全组男性、女性胃癌病人的血清瘦素水平分别为(4.39±3.42)μg/L、(8.97±6.56)μg/L;女性均值高于男性1倍。胃癌病人的血清瘦素水平与BMI显著相关(男性r=0.538,P<0.05;女性r=0.785,P<0.05)。BMI正常的胃癌病人的血清瘦素与健康人无差异。结论:血清瘦素含量可以反映胃癌病人的BMI变化和营养状况,且可作为判断胃癌病人营养状况的指标。

肥胖与胃癌的研究进展

肥胖是一个国际公共卫生问题,其增加了许多慢性疾病(如糖尿病、心血管疾病)的发病风险,也是癌症包括胃癌在内的主要危险因素。肥胖可能通过胃食管反流、胰岛素抵抗、高胰岛素样生长因子及瘦素水平升高、脂联素表达过低、性激素水平改变等引起胃癌发生。幽门螺杆菌感染可导致消化系统及非消化系统疾病,目前研究发现,其与肥胖也密切相关。健康的饮食习惯和体力活动有利于预防肥胖,药物和手术治疗也是控制肥胖的方法。

胃癌患者营养风险筛查和营养支持治疗调查分析

目的了解云南省肿瘤医院收治的胃癌患者营养风险情况及营养支持治疗现状.方法用NRS2002作为筛查工具对云南省肿瘤医院收治的部分胃癌患者进行营养风险筛查,同时调查胃癌患者营养支持治疗情况.结果 (1)本组320例胃癌患者中63%的患者存在营养风险;(2)存在营养风险的胃癌患者血清白蛋白不一定低下、体重指数低下所占比例较高,但体重指数正常的患者同样存在营养风险,存在营养风险的胃癌患者中性别比较无统计学意义(P=0.149),分期比较有统计学意义(P=0.030),年龄比较(<60岁与≥60岁)有统计学意义(P=0.009);(3)存在营养风险的患者中未实施营养支持治疗的占43%;无营养风险的患者实施营养支持治疗的占10%,营养支持治疗的方法主要为肠外营养(PN)、肠内营养(EN)、肠外营养+肠内营养(PN+EN).结论(1)胃癌患者营养风险发生率较高,应进行营养风险筛查.(2)存在营养风险的胃癌患者血清白蛋白不一定都有下降、体重指数低下所占比例较高,但体重指数正常的患者同样存在营养风险,胃癌患者营养风险与性别无关,年龄越大的患者营养风险发生率越高,分期越晚的患者营养风险发生率越高.(3)胃癌营养支持治疗需进一步规范.

家族史、BMI、吸烟、饮酒与贲门癌发病风险及预后的关系

目的:探讨家族史、BMI、吸烟、饮酒与贲门癌发病风险及预后的关系。方法:采用问卷调查记录16605例贲门癌患者和26053例非癌就诊者的家族史、吸烟、饮酒情况,并测量其身高和体质量。对贲门癌患者中电话或住址明确的2000例进行电话或入户随访,以死亡或搬迁为随访中止事件。生存分析及死亡风险评估采用Kaplan-Meier法和Cox模型。结果:家族史阳性明显增加贲门癌的发病风险(P<0.001,OR=2.012,95%CI=1.874～2.160);不同BMI患癌风险有较大差异,低体质量组的患癌风险是正常组的近4倍(OR=3.864,95%CI=3.459～4.317),超重组的患癌风险低于正常组(OR=0.323,95%CI=0.293～0.357);吸烟明显提升贲门癌的发病风险(P<0.001,OR=1.979,95%CI=1.785～2.194),而饮酒对贲门癌发病风险的影响较小(P<0.001,OR=0.749,95%CI=0.678～0.827)。家族史阳性患者生存期优于阴性者(P=0.010,RR=0.677,95%CI=0.502～0.912)。结论:家族史阳性、吸烟和低体质量均提示较高的贲门癌发病风险,而饮酒的作用较弱;家族史阳性可能是贲门癌患者预后较好的独立影响因素。

体重指数与胃癌患者胃切除术术后生存质量的相关性研究

目的初步探讨体重指数与胃癌患者胃切除术术后生存质量的相关性。方法选取该院行胃切除术的早期胃癌患者且符合研究要求的950例病例资料进行回顾性分析,根据患者于术前或术后1年的体重指数(BMI),分别将其分为:低体重组、正常体重组和高体重组。采集患者的年龄、性别、术前到术后1年的BMI、手术类型、胃根治性切除术类型、病理分期和组织学分型。并通过电话随访了解所有患者术后1年的生存情况,计算总生存率和无复发生存率。结果 3组患者的年龄分布、手术类型、胃根治切除术类型、病理分期及组织学分型比较,差异有统计学意义(P<0.05),高体重组术前不同BMI的总生存率高于低体重组和正常体重组,差异有统计学意义(P<0.05)。3组术后1年不同BMI的总生存率和无复发生存率比较,差异具有统计学意义(P<0.05),高体重组>正常体重组>低体重组。多因素分析显示,65岁及以上、术后1年低BMI、R1及R2的姑息性切除、肿瘤病理分期高(Ⅱ、Ⅲ和Ⅳ期)对早期胃癌患者的术后生存起到负向影响,均为风险因素。而术后1年高BMI对早期胃癌患者的术后生存起到正向影响,为保护因素。结论体重干预对于早期胃癌患者行胃切除术的治疗效果的提高具有重要意义,值得临床深入研究与推广。

腹腔镜可调节胃束带术治疗肥胖症的临床研究(附15例报告)

目的:总结腹腔镜可调节胃束带术治疗肥胖症的初步经验及临床效果。方法:根据患者的体重指数(BMI)及其身体条件选择15例肥胖症患者行腹腔镜可调节胃束带术。结果:15例手术均获成功,2例发生并发症,占13.4%,其中1例患者术后出现轻度恶心、呕吐症状,1例患者出现注水池部感染,均经保守治疗治愈。术后随访10个月,减肥效果良好。结论:腹腔镜可调节胃束带术是治疗肥胖症的有效方法,具有安全微创、可调节、可恢复的特点。

体质量指数及腰围不影响胃癌病人的短期手术结局

目的:探讨肥胖及腹型肥胖对于胃癌病人短期手术结局的影响。方法:回顾性收集经腹胃切除+D2淋巴结清扫术的226例胃癌病人临床资料。手术前分别测量身高、体重和腰围,根据体质量指数(BMI),将病人分为非肥胖组、超重组和肥胖组;根据腰围,将病人分为非腹型肥胖组、腹型肥胖组。比较各组病人术中出血量、手术时间、术后住院天数、术后胃周淋巴结检出数及术后并发症。结果:非肥胖组、超重组、肥胖组3组间的平均手术时间(P=0.451)、平均术中出血量(P=0.949)、平均术后住院天数(P=0.745)、平均总淋巴结检出数(P=0.165)无统计学差异。非腹型肥胖组与腹型肥胖组间的手术时间(P=0.886)、平均术中出血量(P=0.596),平均术后住院天数(P=0.555)、平均总淋巴结检出数(P=0.209)亦无统计学差异。术后27例发生早期并发症,发生率为12.3%,其在BMI非肥胖组、超重组、肥胖组(P=0.394)间及非腹型肥胖组、腹型肥胖组(P=0.846)间均无统计学差异。结论:BMI及腰围不影响胃癌病人的手术时间、出血量、住院天数、淋巴结检出数及早期术后并发症。

超重对行胃癌根治术患者近期临床疗效的影响

目的探讨超重对于胃癌根治术近期疗效的影响。方法回顾性收集2009年1月至2012年12月于我科行胃癌根治术的患者166例(超重组102例,非超重组64例),比较两组患者术中、术后以及近期生存情况。结果超重组手术时间明显长于非超重组[(237.70±59.16)min vs.(210.55±54.49)min,P<0.05)),术中出血量亦明显高于非超重组[(346.41±223.63)mL vs.(276.77±155.46)mL,P<0.05)];两组的术中总淋巴结清扫数、肛门排气时间、进食时间、术后住院时间以及术后并发症的差异均无统计学意义。超重组和非超重组的3年生存率分别为76.8%和65.1%,差异无统计学意义(P>0.05)。结论超重会延长手术时间和增加术中的出血量,但不会影响手术的近期疗效。