Body Mass Index (BMI) as a Prognostic Factor Influencing Outcomes of Gastric Cancer Resection Including Curative Gastrectomy

Abstract

Background/aim: This study evaluated the influence of the body mass index (BMI) on outcomes of gastric cancer resection, with a specific focus on curative gastrectomy.

Patients and methods: A total of 756 patients who underwent gastric cancer resection, including 372 cases of curative gastrectomy, were analyzed. The impact of BMI on overall, systemic, and surgical complications, as well as on relaparotomy, perioperative mortality, and 5-year survival was examined.

Results: Underweight (BMI <18.5 kg/m²), and obesity (BMI ≥30 kg/m²) were identified as independent risk factors for overall complications (p<0.0001, and p<0.0001), systemic complications (p<0.0001, and p=0.001), and surgical complications (p<0.0001, and p=0.023) in all gastric cancer resections. Similar trends were observed for curative gastrectomy, where underweight and obese patients demonstrated more overall complications (p<0.0001, and p<0.0001), systemic complications (p<0.001, and p=0.0001), and surgical complications (p<0.0001, and p=0.0032). No differences in 5-year survival were observed among BMI categories in 372 cases of curative gastrectomy. However, being underweight was associated with a poorer 5-year survival in all 756 cases of gastric cancer resection (odds ratio=0.45, 95% confidence interval= 0.27-0.73, p=0.0016).

Conclusion: BMI significantly influences the outcomes of gastric cancer resection, with underweight and obese patients demonstrating higher complication rates. Underweight status is also linked to poorer long-term survival in the broader gastric cancer population but not in curative resection cases.

Keywords: BMI; Gastric cancer resection; obesity; prognostic factor.