Journal Article

Association of preoperative body mass index with postoperative complications and survival for patients with gastric cancer: A systematic review and meta-analysis

Cui, Lili, Sun, Jing, Liu, Wanlu, Li, Zhenzhen

2025

Overview

The relationship among body mass index (BMI), postoperative complications, and clinical outcomes in patients undergoing gastrectomy for gastric cancer remains unclear. This study aimed to evaluate this association using a meta-analysis. We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases up to February 25, 2024. Patients were classified into underweight (<18.5 kg/m2), normal weight (18.5-25.0 kg/m2), and overweight (≥25.0 kg/m2) groups based on BMI categories. Meta-analysis was performed using a random-effects model. Additionally, exploratory sensitivity and subgroup analyses were performed. Twenty-two studies involving 41,144 patients with gastric cancer were included for quantitative analysis. Preoperative underweight (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55; P = 0.024) and overweight (OR: 1.19; 95%CI: 1.09-1.30; P <0.001) were associated with an increased risk of postoperative complications. Furthermore, preoperative underweight was associated with poorer overall survival (hazard ratio [HR]: 1.40; 95%CI: 1.28-1.53; P <0.001), whereas preoperative overweight was associated with better over-survival (HR: 0.82; 95%CI: 0.73-0.91; P <0.001). Furthermore, preoperative underweight was not associated with disease-free survival (HR: 1.48; 95%CI: 0.97-2.26; P = 0.069), whereas preoperative overweight was associated with longer disease-free survival (HR: 0.80; 95%CI: 0.70-0.91; P = 0.001). In terms of specific postoperative complications, preoperative underweight was associated with an increased risk of septic shock (OR: 3.40; 95%CI: 1.26-9.17; P = 0.015) and a reduced risk of fever (OR: 0.39; 95%CI: 0.18-0.83; P = 0.014). Preoperative overweight was associated with an increased risk of wound infections (OR: 1.78; 95%CI: 1.08-2.93; P = 0.023), intestinal fistula (OR: 5.23; 95%CI: 1.93-14.21; P = 0.001), arrhythmia (OR: 6.38; 95%CI: 1.70-24.01; P = 0.006), and pancreatic fistula (OR: 3.37; 95%CI: 1.14-9.96; P = 0.028). This study revealed that both preoperative underweight and overweight status were associated with an increased risk of postoperative complications. Moreover, the postoperative survival outcomes were significantly better in overweight compared to that of underweight patients. Registration: INPLASY202480004.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analysis / Antigens / Arrhythmia / Biology and Life Sciences / Body Mass Index / Body size / Body weight / Cancer / Cancer patients / Care and treatment / Complications / Complications and side effects / Data collection / Development and progression / Event history analysis / Fistula / Fistulae / Gastrectomy / Gastrectomy - adverse effects / Gastric cancer / Health aspects / Health risks / Humans / Medical prognosis / Medicine and Health Sciences / Meta-analysis / Methods / Obesity / Oncology, Experimental / Overweight / Overweight - complications / Patient outcomes / Patients / Physical Sciences / Postoperative / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - mortality / Preoperative Period / Research and Analysis Methods / Risk Factors / Risk management / Septic shock / Stomach cancer / Stomach Neoplasms - mortality / Stomach Neoplasms - surgery / Subgroups / Surgery / Survival / Systematic review / Thinness - complications / Underweight / Wound infection