PD1043 - THE OBESITY PARADOX: IMPACT ON SURVIVAL FOLLOWING SEVERE COMPLICATIONS IN GASTRIC CANCER SURGERY.

PD1043

THE OBESITY PARADOX: IMPACT ON SURVIVAL FOLLOWING SEVERE COMPLICATIONS IN GASTRIC CANCER SURGERY.

O. Abdel-Lah Fernández^1,2,*, J. Nieto¹, M. Torres Jurado¹, B. Chacón Cordero^2,3, C. Ruiz-Gorjón⁴, L. Cosido^1,2, M. Borrego¹, P. I. Dorado-Díaz², F. Parreño^1,2

¹Surgery, Complejo Asistencial Universitario de Salamanca, ²Universidad de Salamanca, Salamanca, Spain, ³Universidad de Costa Rica, San Jose, Costa Rica, ⁴Primary care, SACYL, Salamanca, Spain

Rationale: The "obesity paradox" suggests a survival benefit for patients with higher BMI in various clinical settings. In gastric cancer surgery, where patients are highly susceptible to acute catabolism and severe morbidity, the role of metabolic reserves is critical. This study aimed to evaluate whether a higher BMI provides a protective advantage in patients who experience severe postoperative complications.

Methods: We conducted a retrospective analysis of 158 patients undergoing curative-intent surgery for gastric cancer.  Patients were stratified by BMI (>25 kg/m² vs. ≤25 kg/m²) and the occurrence of severe complications (Clavien-Dindo [CD] ≥III). The interaction between BMI, systemic inflammation (mGPS), and outcomes was analyzed using Kaplan-Meier curves and multivariable regression models.

Results: Patients with a BMI >25 kg/m² demonstrated a consistent trend toward lower rates of severe morbidity (20% vs. 27%) and a 50% reduction in surgical reinterventions (7%vs.14%) compared to normal-weight patients. Most importantly, among the subgroup of patients who suffered severe complications, those with overweight or obesity (BMI >25) showed notably better Overall Survival than normal-weight patients with similar complications (log-rank p=0.045 across groups).  A higher baseline BMI appeared to act as a physiological "buffer" against the metabolic stress of severe surgical morbidity.

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Conclusion: Our findings support the obesity paradox hypothesis in gastric cancer surgery. A higher baseline BMI may provide critical metabolic resilience, significantly improving survival in patients who face severe postoperative complications. These results emphasize the importance of preserving or enhancing nutritional reserves preoperatively to mitigate the impact of surgical stress and improve oncological resilience.

Disclosure of Interest: None declared