关键词: 中心型肥胖, 胃肿瘤, 远端胃大部切除术, 腹腔镜, 预后, 倾向性评分匹配法

Abstract: Objective To evaluate the effect of central obesity on the clinical efficacy of laparoscopic D2 radical gastrectomy for distal gastric cancer. Methods The clinical and pathological data of 168 patients with distal gastric cancer who underwent laparoscopic D2 radical gastrectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from April 2013 to January 2021 were collected.The male waist circumference ≥85 cm and female waist circumference ≥80 cm were divided into two groups.There were 64 cases in obesity group and 104 cases in non-obesity group.Propensity score matching method was used to balance the clinical baseline characteristics of the two groups except BMI and waist circumference.The operation related indexes,postoperative complications indexes,postoperative pathological indexes and prognostic survival indexes were compared between the two groups after matching. Results Before matching,there were significant differences in age and anesthesia risk score between obese group and non-obese group(except BMI and waist circumference)( P <0.05).After matching,61 cases in obesity group and 61 cases in non-obesity group were matched successfully.There was no significant difference in basic data(except BMI and waist circumference) between the two groups( P >0.05).The operation related indexes of the two groups were compared,the operation time,intraoperative blood loss and postoperative hospital stay were(219.8±33.6)min,(156.6±55.1) ml and(14.6±2.3) days in obese group and(198.2±24.7) min,(122.1±44.3) ml and(13.4±2.7) days in non-obese group,the difference was statistically significant( P <0.05).The recovery time of gastrointestinal function was(3.0±0.8) days in the obese group and(2.8±0.9) days in the non-obese group,the difference was not statistically significant(P >0.05).Comparison of postoperative complications between the two groups,there were 15 patients with 22 complications in the obese group and 13 patients with 18 complications in the non-obese group,the difference was not statistically significant( P >0.05).Comparison of postoperative pathological indexes between the two groups,the number of lymph nodes in obese group was(21.9±4.2),the rate of lymph node metastasis was 77.0%,the number of positive lymph nodes was(3.3±2.4),the number of pTNM stage Ⅰ/Ⅱ/Ⅲ was 17/23/21,and the numbers of non-obese group were(22.4±5.6),70.5%,(3.1±2.4) and 19/23/19,the difference was not statistically significant( P >0.05).Comparison of prognosis and survival indexes between the two groups,there were 16 patients died of tumor recurrence and metastasis in obese group and 14 patients died of tumor recurrence and metastasis in non-obese group.There was no significant difference in overall survival between the two groups The difference was not statistically significant( P >0.05). Conclusion Central obesity increases the difficulty of laparoscopic D2 radical gastrectomy for distal gastric cancer.The recovery of patients with central obesity is slower,but the prognosis is not affected.

Key words: central obesity, stomach neoplasms, distal gastrectomy, laparoscopy, prognosis, propensity score matching