71994 - The Impact of Obesity on Surgical Outcomes after Esophagectomy for Cancer in Sweden

Introduction The rising global obesity rates are closely tied to an increased risk of esophageal cancer. While obesity is linked to more postoperative complications, its impact on long-term survival after esophagectomy remains debated. This study aims to explore obesity's influence on survival and postoperative complications in a national cohort of esophageal resection patients. Method We conducted a retrospective study using data from Sweden's national quality register for esophageal and gastric cancer (NREV) covering 2006-2018. The cohort was categorized based on BMI: underweight (BMI < 20), normal (BMI 20-25), overweight (BMI 25-30), and obese (BMI > 30). Kaplan-Meier was used for survival analysis, while logistic regression and Cox regression was used for adjusted analyses. Covariates included sex, age, comorbidities, histopathology, and disease stage. Result Out of 1742 individuals (mean age 66, 79.9% males), 242 (13.9%) were obese. Obese patients had more comorbidities and more adenocarcinomas. Surgical complications risk for obese individuals was similar to normal-weight (OR: 0.83 [0.56-1.21]). However, obese patients had a higher risk of other complications (OR: 1.78 [1.22-2.60]). Surprisingly, obese individuals had a lower risk of death (HR: 0.74 [0.58-0.95]) and better 5-year survival. Discussion Despite more comorbidities, obese patients undergoing esophageal resection showed comparable surgical complication risks but higher other complication risks. Notably, they exhibited a reduced overall death risk and superior 5-year survival compared to normal-weight patients.