• Marcovalerio Melis, Jill Weber, Ravi Shridhar, Sarah Hoffe, Khaldoun Almhanna, Richard C Karl, and Kenneth L Meredith.
• Department of Surgery, New York University Medical School, New York, New York, USA.
• BMJ Open. 2013 Jan 1;3(5).

ObjectiveGiven the increasing rate of obesity, the effects of excessive body weight on surgical outcomes constitute a relevant quality of care concern. Our aim was to determine the relationship between preoperative body mass index (BMI) on perioperative complications after oesophagectomy for adenocarcinoma of the oesophagus.DesignRetrospective database review.SettingSingle institution high volume oncological tertiary care referral centre.ParticipantsFrom our comprehensive oesophageal cancer database consisting of 709 patients, we stratified patients according to BMI: 155 normal-weight (BMI 20-24), 198 overweight (BMI 25-29) and 187 obese (BMI ≥30) patients.InterventionsAll patients underwent oesophagectomy for cancer.Primary And Secondary Outcome MeasuresIncidences of preoperative risk factors and perioperative complications in each group were analysed.ResultsThe patient cohort consisted of 474 men and 66 women with a mean age of 64.3 years (28-86). They were similar in terms of demographics and comorbidities, with the exception of a younger age (65.2 vs 65.4 vs 62.5 years, p=0.0094), and a higher incidence of diabetes (9.1% vs 13.2% vs 22.7%, p=0.001), hiatal hernia (16.8% vs 17.8% vs 28.8%, p=0.009) and Barrett oesophagus (24.7% vs 25.4% vs 36.2%, p=0.025) for obese patients. The type of surgery performed, overall blood loss, extent of lymphadenectomy, R0 resections and complications were not influenced by BMI on univariate and multivariate analysis.ConclusionsIn our experience, patients with an elevated BMI and oesophageal adenocarcinoma do not experience an increase in morbidity and mortality after oesophagectomy as stated in previous reports, when performed at a high volume centre. Additionally, BMI did not affect the quality of oncological resection as determined by number of harvested lymph-nodes and rates of R0 resections.Trial RegistrationMCC 15030, IRB 105286.

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