Is There any Role of Visceral Fat Area for Predicting Difficulty of Laparoscopic Gastrectomy for Gastric Cancer?

PURPOSE: Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications. MATERIALS AND METHODS: A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI ( or =25 kg/m2) and VFA ( or =100 cm2). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups. RESULTS: The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively). CONCLUSIONS: VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.

Current Available Options in Bariatric Surgery and Their Clinical Outcomes / 임상당뇨병

Patients that are morbidly obese require various treatments to reduce the potential health risks associated with obesity-related chronic diseases. Compared to medical management, bariatric surgery can effectively reduce body weight and treat obesity-associated metabolic diseases. Although there are some endoscopic bariatric procedures, the most commonly performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), sleeve gastrectomy (SG) and biliopancreatic diversion (BPD). These types of bariatric surgery can be performed laproscopically with low rates of complications, and generally result in comparable weight loss to medication and lifestyle modification and remission of type 2 diabetes mellitus. Thus, in this study, we describe the current options for bariatric surgery and offer a synopsis of the data on post-operative outcomes.

Surgical Management of Advanced Gastric Cancer

Although the proportion of early gastric cancer has increased, that of advanced gastric cancer (AGC) is still high. The overall prognosis of AGC has gradually improved over the past decades with advances in surgical techniques as well as multimodality treatments. Nevertheless, the outcome of AGC still remains poor and worldwide standard treatment guideline has not been established. Radical gastrectomy is the gold standard of management or gastric cancer worldwide, as the complete surgical removal of tumors (R0 resection) confers the only chance for cure. However, the extent of lymph node dissection has been debated between East and West. Radical gastrectomy with extended D2 lymphadenectomy is the accepted standard in Eastern countries, whereas limited D1 lymphadenectomy with chemoradiotherapy is more frequently used in Western countries. Role of splenectomy and laparoscopic surgery for AGC is still debatable and should be proved by long-term oncologic outcomes from large-scale randomized controlled trials.