Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis.
Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis.
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DOI：
10.1097/md.0000000000011091
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发表时间：
2018-07
期刊：
影响因子：
1.6
通讯作者：
Jing T
中科院分区：
文献类型：
--
作者：
Gao H;Feng HM;Li B;Lin JP;Yang JB;Zhu DJ;Jing T
高体重指数（BMI, bbb23 / 25kg /m2）对食管癌（EC）术后手术结局和预后的影响仍有争议。我们在此进行了一项系统综述和荟萃分析，以确定高BMI与食管癌切除术患者手术结果和预后之间的关系。研究检索通过检索PubMed、Embase、Web of Science和CNKI（截至2017年9月8日）的出版物进行。这项荟萃分析纳入了19项研究，13756名患者。我们发现，高BMI与较高的伤口感染发生率密切相关(优势比[OR]: 1.41, 95%可信区间[CI]: 1.02-1.97, P =。2004)，心血管并发症（OR: 2.51, 95% CI: 1.65 ~ 3.81, P < 0.05）。0001)，吻合口漏(OR: 1.50, 95% CI, 1.21-1.84, P =。0002)，但乳糜漏的发生率较低(OR: 0.59, 95% CI, 0.40-0.88, P =。01)。高BMI组与总生存期（OS）的好坏无关(风险比[HR]: 0.95, 95% CI: 0.85-1.07, P =。4)和无病生存率(HR: 0.95, 95% CI: 0.72 ~ 1.25, P =。72)高于BMI正常组。然而，在亚组分析中，多因素分析产生的HR汇总结果表明，高BMI可以改善EC患者的OS （HR: 0.84, 95% CI, 0.76-0.93, P < 0.01）。超重的EC患者不应拒绝手术治疗，但必须强调术中预防和术后对几种手术并发症的仔细监测。此外，高BMI可能是EC患者的预后预测因子；进一步的研究是必要的。
The impact of high body mass index (BMI, >23/25 kg/m2) on surgical outcomes and prognosis in patients with esophageal carcinoma (EC) after undergoing esophagectomy remains controversial. We herein conducted a systematic review and meta-analysis to determine the relationship between high BMI and surgical outcomes and prognosis in patients undergoing esophagectomy for EC. The study search was conducted by retrieving publications from the PubMed, Embase, Web of Science, and CNKI (up to September 8, 2017). Nineteen studies with 13,756 patients were included in this meta-analysis. We found that high BMI was closely associated with a higher incidence of wound infection (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.02–1.97, P = .04), cardiovascular complications (OR: 2.51, 95% CI, 1.65–3.81, P < .0001), and anastomotic leakage (OR: 1.50, 95% CI, 1.21–1.84, P = .0002), but a lower incidence of chylous leakage (OR: 0.59, 95% CI, 0.40–0.88, P = .01) when compared with normal BMI. The high BMI group was not associated with better or worse overall survival (OS) (hazard ratio [HR]: 0.95, 95% CI, 0.85–1.07, P = .4) and disease-free survival (HR: 0.95, 95% CI, 0.72–1.25, P = .72) than the normal BMI group. However, in the subgroup analysis, the pooled result of HRs generated from multivariate analyses suggested that high BMI could improve OS in EC patients (HR: 0.84, 95% CI, 0.76–0.93, P < .01). Overweight patients with EC should not be denied surgical treatment, but intraoperative prevention and careful postoperative monitoring for several surgical complications must be stressed for this population. Besides, high BMI might be a prognostic predictor in EC patients; further studies are warranted.