Background: Obesity is a growing epidemic around the world, and obese patients are generally regarded as high\nrisk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of\nobesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.\nMethods: We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004\nand December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were\ncompared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used\nmethods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more\nsuitable for obese patients.\nResults: A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study\nperiod. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 �± 29.7\nvs. 227.2 �± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 �± 34.1\nvs. 136.9 �± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly\nshorter in the non-obese group than in the obese group (3.3 �± 0.8 vs. 3.6 �± 0.9 days; 4.3 �± 1.0 vs. 4.6 �± 1.0 days; and 9.\n0 �± 2.2 vs. 9.6 �± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as\ncompared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved\nresults for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.\nConclusions: Obesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic\ngastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese\npatients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early\nsurgical outcomes, for obese patients.
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