Effect Of Body Mass Index On Postoperative Short-term Outcomes Of Laparoscopy-assisted Radical Gastrectomy:A Meta-analysis

Objective:The aim of this study was to evaluate the effect of body mass index(BMI) on postoperative short-term outcomes of Laparoscopy-assisted radical gastrectomy by performing a meta-analysis.Methods:A literature search was performed in Pub Med, EMBASE, Cochrane Library databases, CNKI, and Sino Med, Wanfang database for clinical research that compared outcomes between high BMI and low BMI patients in laparoscopy-assisted radical gastrectomy.published before October 2014. Inclusion and exclusion criteria were established and applied. The outcome variables analyzed were operative time,blood loss, number of harvested lymph nodes, hospital stay, first flatus day and postoperative complications.Results:(1)Effect of BMI on intraoperative and postoperative situation of LARGThe twelve studies involved a total 4762 gastric cancer patients after laparoscopy-assisted radical gastrectomy(LARG).There were 1215 patients in high BMI group(BMI≥25 kg/m2)and 3547 patients in low BMI group(BMI <25kg/m2).Compared with the low BMI group, high BMI group were associated with longer operation time( SMD= 0.64, 95%CI : 0.35~ 0.93, P<0.0001), more intraoperative blood loss(SMD= 0.63,95%CI:0.24 ~ 1.03,P=0.002), less retrieved lymph nodes(SMD=-0.44,95%CI:-0.72~-0.17,P=0.002),and more overall postoperative complications(OR= 1.44,95%CI:1.19~ 1.74,P=0.0002); there was no significant statistical difference in postoperative hospital stay( SMD= 0.05,95%CI:-0.02~ 0.13,P=0.16),the time of first flatus(SMD= 0.04,95%CI:-0.03~0.12,P=0.25) and anyone complication.(2)Effect of BMI on intraoperative and postoperative situation of LADGThere are seven studies for 2027 patients underdoing laparoscopy-assisted distal gastrectomy(LADG),There were 514 patients in high BMI group and 1513 patients in low BMI group. Also, high BMI group were associated with longer operation time(SMD= 0.85,95%CI:0.20~ 1.50,P=0.010), more intraoperative blood loss(SMD= 0.85,95%CI:0.18~ 1.51,P=0.01), more overall postoperative complications(OR= 1.84,95%CI:1.32~ 2.55,P=0.0003) than the low BMI group.There was no significant statistical difference in retrieved lymph nodes(SMD=-0.60,95%CI:-1.33~ 0.12,P=0.10) and a particular complications.Conclusious:For East Asian populations, the higher BMI might increase the peration time,intraoperative blood loss and the incidence rate of overall postoperative complications of Laparoscopy-assisted radical gastrectomy. But a particular complications were not obvious effect by BMI.The effect on retrieved lymph nodes should be evaluated by more studies.