An Elevated Body Mass Index Does Not Reduce Survival After Esophagectomy for Cancer

• Published in: Annals of surgical oncology Vol. 18; no. 3; pp. 824 - 831
• Main Authors: Melis, Marcovalerio, Weber, Jill M., McLoughlin, James M., Siegel, Erin M., Hoffe, Sarah, Shridhar, Ravi, Turaga, Kiran K., Dittrick, George, Dean, E. Michelle, Karl, Richard C., Meredith, Kenneth L.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-03-2011; Springer Nature B.V
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Body Mass Index; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Combined Modality Therapy; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy; Female; Gastrointestinal Oncology; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Obesity; Oncology; Overweight; Perioperative Care; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Body Mass Index; Esophageal Cancer; Obese Patient; High Body Mass Index; Overall Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1336-1

Background
Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer.
Methods
Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25–29), and normal-weight (BMI 20–24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan–Meier method, and differences were analyzed by log rank method.
Results
The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years,
P
 = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%,
P
 = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%,
P
 = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%,
P
 = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%,
P
 = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%,
P
 = 0.01 and 48, 44, 34%,
P
 = 0.01).
Conclusions
In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer.