Influence of body mass index on outcomes after major resection for cancer

Surgery. 2015 Aug;158(2):472-85. doi: 10.1016/j.surg.2015.02.023. Epub 2015 May 23.


Background: Evidence supporting worse outcomes among obese patients is inconsistent. This study examined associations between body mass index (BMI) and outcomes after major resection for cancer.

Methods: Data from the 2005-2012 ACS-NSQIP were used to identify cancer patients (≥18 years) undergoing 1 of 6 major resections: lung surgery, esophagectomy, hepatectomy, gastrectomy, colectomy, or pancreatectomy. We used crude and multivariable regression to compare differences in 30-day mortality, serious and overall morbidity, duration of stay, and operative time among 3 BMI cohorts defined by the World Health Organization: normal versus underweight, overweight-obese I, and obese II-III. Propensity-scored secondary assessment and resection type-specific stratified analyses corroborated results.

Results: A total of 529,955 patients met inclusion criteria; 32.06% had normal BMI, 3.45% were underweight, 32.52% overweight, and 17.76%, 7.51%, and 4.94% obese I-III, respectively. Risk-adjusted outcomes for underweight patients consistently were worse. Overweight-obese I fared similarly to patients with normal BMI but had greater odds of isolated complications. Obese II-III patients experienced only marginally increased odds of morbidity. Analyses among propensity-scored cohorts and stratified by cancer-resection type reported similar trends. Worse outcomes were observed among morbidly obese hepatectomy and pancreatectomy patients.

Conclusion: Evidence-based assessment of outcomes after major resection for cancer suggests that obese patients should be treated with the aim for optimal oncologic standards without being hindered by a misleading perception of prohibitively increased perioperative risk. Underweight and certain types of morbidly obese patients require targeted provision of appropriate care.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index*
  • Databases, Factual
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Neoplasms / mortality
  • Neoplasms / surgery*
  • Obesity / complications*
  • Operative Time
  • Overweight / complications
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality
  • Retrospective Studies
  • Risk Factors
  • Thinness / complications*
  • Treatment Outcome
  • Young Adult