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The Impact of Preoperative Underweight Status on Postoperative Complication and Survival Outcome of Gastric Cancer Patients: A Systematic Review and Meta-analysis

Abstract Objective: In this study, we performed a systematic review and meta-analysis to evaluate the impact of preoperative underweight status on postoperative complications and survival outcome of gastric cancer (GC) patients. Methods: The related studies were identified by searching PubMed and Embase databases. According to the body mass index (BMI), all patients were classified into underweight group (<18.5 kg/m2) and normal weight group (≥18.5 kg/m2, <25 kg/m2). The relevant data were extracted and pooled effect size were assessed using a fixed effect model or random effect model. Results: A total of 12 studies were included in this meta-analysis. The results indicated that underweight patients had a higher risk of postoperative complications than normal weight patients (RR: 1.28, 95% CI: 1.01–1.61, P < 0.05; I2 = 57.3%), especially for pulmonary infection (RR: 1.58, 95% CI: 1.03–2.43, P < 0.05; I2 = 47.7%). However, there was no significant difference between underweight and normal weight patients for major surgery-related complications such as anastomotic leakage, wound infection, and intra-abdominal infection. In addition, the short-term (RR: 2.12, 95% CI: 1.47–3.06, P < 0.001; I2 = 0%) and long-term survival (HR: 1.53, 95% CI: 1.14–2.07, P < 0.01; I2 = 64.0%) of underweight patients was significantly poorer than that of normal weight patients. Conclusion: Preoperative underweight status was significantly associated with unfavorable postoperative outcome of GC patients. The status may represent excessive nutritional consumption and malnutrition resulting from aggressive tumor.