Predictive Value of Body Mass Index for Short-Term Outcomes of Patients with Esophageal Cancer After Esophagectomy: A Meta-analysis

Background. The association between body mass index (BMI) and short-term outcomes after esophagectomy remains controversial. Methods. A meticulous search for articles describing the association between BMI and perioperative outcomes after esophagectomy was conducted using PubMed, EMBASE, and the Cochrane Library. The study classified BMI according to the World Health Organization definitions and Asian-specific BMI cutoff values. Normal weight was selected as the comparator, and the odds ratio (OR) was calculated as the primary effect. Results. This meta-analysis included 13 studies with 5480 patients. Obese patients exhibited higher risks of overall complication (OR 1.37; P=0.013), anastomotic leakage (OR 1.74; P=0.001), and thromboembolic complications (OR 2.05; P=0.039). Subgroup analysis indicated that obese patients from Western countries had a higher risk of wound infection (OR 2.22; P=0.022), whereas obese Asians were more likely to experience pulmonary complications (OR 1.64; P=0.002). Overweight patients displayed no significant differences in major complications relative to normal-weight patients, except for the increased risk of overall complications (OR 1.32; P=0.030). Additionally, underweight patients showed increased incidence of pulmonary complications (OR 1.92; P=0.020 and anastomotic leakage (OR 1.64; P=0.034). Morbid obesity also was analyzed separately with limited data, and this group displayed a higher risk of wound infection (OR 1.62; P=0.027) and thromboembolic complications (OR 2.65; P=0.003). No significant differences in mortality were observed among patients in different BMI categories. Conclusions. Obesity and underweight statuses were confirmed risk factors for several complications after esophagectomy, whereas overweight patients tended to experience greater benefit from surgery.