1. The Effect of Obesity on the Radicality of Subtotal Oesophagectomy for Oesophageal Adenocarcinoma S Wahed, HV Jones, A Krishnan, J Shenfine, SM Griffin Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle Upon Tyne

2. BMI Distribution in English Men 1993-2010 Health Surveys for England, 2010

3. Obesity as a Risk Factor OBESITY GORD BARRETT’S METAPLASIA OESOPHAGEAL ADENO- CARCINOMA 1.Association between Body Mass Index and adenocarcinoma of the esophagus and gastric cardia, Lagergren et al, Ann Intern Med, 1999;130:883-90 2.Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus, Whiteman et al, Gut, 2008: 57:173-180 3.Body mass index, height and risk of adenocarcinoma of the oesophagus and gastric cardia: a prospective cohort study, Merry et al, Gut 2011:56 1503-1511

4. Oesophagectomy in the Obese

5. Author, Year NHistology Average Lymph Node Yield Complications 5 Year Survival (p value) Scarpa 2012 278MixedNot statedReduced respiratory complications in obese Similar 0.05 Blom 2012 736Mixed18 -19 Increased anastomotic leak in obesity Similar 0.517 Melis 2011 490Mixed8.5 -9.2Overall similarIncreased 0.01 Madani 2010 142Adenocarcinoma only 13Increased respiratory complications in obesity Increased 0.008 Grotenhuis 2010 556Mixed9-12Increased anastomotic leak and severe complications in obesity Similar 0.25 Healy 2007 150Adenocarcinoma only 10-15Increased respiratory complications and anastomotic leak in obesity Similar 0.348 Morgan 2007 215Mixed11-14Increased wound infections in obesity Similar 0.689

6. Aims 1.Evaluate the changing trends of obesity in patients with adenocarcinoma undergoing subtotal oesophagectomy in the North East of England 2.Evaluate the effect of obesity on radical lymphadenectomy 3.Evaluate the effect of obesity on post-operative complications 4.Evaluate the effect of obesity on long-term survival

7. Methods NOGCU prospective database: Jan 2000 – Dec 2010 Two phase subtotal oesophagectomy with radical 2 field lymphadenectomy only Oesophageal adenocarcinoma only WHO BMI criteria – Underweight <18.5kg/m 2 – Normal 18.5kg/m 2 - 24.99kg/m 2 – Overweight 25kg/m 2 - 29.99kg/m 2 – Obese ≥30kg/m 2

8. 592 Oesophagectomies 2000-2010 422 (71%) Oesophagectomies for adenocarcinoma 4o8 Oesophagectomies for adenocarcinoma 385 Oesophagectomies for adenocarcinoma with recorded BMI 23 No BMI recorded 14 Other operative approach 170 Other histology

9. Median BMI 27.2 Median BMI 26.0 Body Mass Index Distribution with Time p = 0.065

10. Number of Patients per BMI Category International Society for Diseases of the Esophagus, Venice, 2012

11. Demographic Normal Weight OverweightObesep value % Male 8584830.946 Median Age 66 60<0.001

12. Demographic Normal Weight OverweightObesep value % Male 8584830.946 Median Age 66 60<0.001 p = 0.041 Percentage with disease Barrett’s Oesophagus

13. Demographic Normal Weight OverweightObesep value % Male 8584830.946 Median Age 66 60<0.001 p = 0.041p = 0.650 Percentage with disease Barrett’s OesophagusReflux Disease

14. Perioperative Outcome Normal Weight OverweightObesep value Median Op Time / min 3683703900.052 R0 Resection rate / % 9794960.604 Median Number Lymph Nodes 3430330.178 Lymph Node Ratio / % 0.050.0200.108 Lymph Node Negative / % 3749560.020

15. StageNormal WeightOverweightObese* 02 (2%)4 (2%)1 (1%) 118 (16%)45 (27%)30 (32%) 2a22 (19%)33 (20%)21 (23%) 2b14 (12%)21 (13%)10 (11%) 357 (49%)64 (38%)30 (32%) 43 (3%)1 (1%) *compared to normal p = 0.040

16. Complication Normal Weight OverweightObeseOverall p value All / %65.561.366.763.90.585 Respiratory / %23.326.235.527.60.126 Wound / %13.814.919.415.60.510 Chyle Leak / %11.25.44.36.90.084 Anastomotic Leak / % 7.86.57.57.20.916 In-Hospital Mortality / % 4.32.41.12.70.336

17. Overall Survival Log rank, p = 0.003

19. Conclusions 1.Median BMI has increased with time 2.Obese patients have equally radical lymphadenectomy as normal weight patients 3.Wound and respiratory complications are more common in obese patients but overall complication rate is similar between groups 4.Overall and disease-free survivals are not significantly different between BMI groups, once patients are stage matched

20. Acknowledgements Helen Jaretzke Database Manager NOGCU Angela Tait Database Clerk NOGCU

21. The Effect of Obesity on the Radicality of Subtotal Oesophagectomy for Oesophageal Adenocarcinoma S Wahed, HV Jones, A Krishnan, J Shenfine, SM Griffin Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK