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Preoperative visceral fat area predicts intraoperative adverse events during lymphadenectomy in laparoscopic gastrectomy for gastric cancer: a post hoc analysis
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Preoperative visceral fat area predicts intraoperative adverse events during lymphadenectomy in laparoscopic gastrectomy for gastric cancer: a post hoc analysis
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Preoperative visceral fat area predicts intraoperative adverse events during lymphadenectomy in laparoscopic gastrectomy for gastric cancer: a post hoc analysis
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Journal Article
Preoperative visceral fat area predicts intraoperative adverse events during lymphadenectomy in laparoscopic gastrectomy for gastric cancer: a post hoc analysis
2025
Overview
Background
Visceral obesity has been increasingly recognized as a potential risk factor for surgical complications in gastric cancer surgery, yet its impact on lymphadenectomy during laparoscopic gastrectomy remains undefined. This study aimed to investigate the influence of visceral fat area (VFA) on intraoperative adverse events (iAEs) during lymphadenectomy in laparoscopic gastrectomy.
Methods
A post hoc analysis was performed using data from two previous prospective studies ([NCT02327481] and [NCT01609309]). The patients were divided into high and low VFA groups based on preoperative computed tomography images at the umbilical level. All iAEs were reviewed from the surgical videos and graded using ClassIntra. The factors influencing iAEs were identified, and predictive models for iAEs were constructed.
Results
This study included 490 patients, with 244 and 246 patients in the high and low VFA groups, respectively. Restricted cubic splines demonstrated a positive linear association between VFA and iAEs. Compared with the low VFA group, the high VFA group exhibited a significantly higher incidence of iAEs (29% vs. 12%,
p
< 0.001), primarily in the infrapyloric (9.0% vs. 2.0%) and suprapancreatic (23.4% vs. 9.3%) regions and higher rates of ClassIntra I-III. Multivariate logistic regression identified high VFA as an independent risk factor for iAEs (hazard ratio [HR] 2.16, 95% confidence interval [CI]: 1.22 − 3.83). Based on the VFA, nomograms were developed to predict iAEs (training area under the curve [AUC] 0.722, validation AUC 0.730). Meanwhile, a web-based calculator was developed to facilitate clinical application.
Conclusions
High preoperative VFA is independently correlated with iAEs after laparoscopic gastrectomy for gastric cancer. Nomograms based on VFA showed potential in predicting iAEs, helping identify high-risk patients early and facilitating tailored perioperative management.
Graphical abstract
Publisher
Springer US,Springer Nature B.V
Subject
/ Aged
/ Female
/ Gastrectomy - adverse effects
/ Humans
/ Intra-Abdominal Fat - diagnostic imaging
/ Intraoperative Complications - epidemiology
/ Intraoperative Complications - etiology
/ Laparoscopy - adverse effects
/ Lymph Node Excision - adverse effects
/ Male
/ Medicine
/ Obesity, Abdominal - complications
/ Surgery
