{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:41:03Z","timestamp":1783341663404,"version":"3.54.6"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The relationship among body mass index (BMI), postoperative complications, and clinical outcomes in patients undergoing gastrectomy for gastric cancer remains unclear. This study aimed to evaluate this association using a meta-analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases up to February 25, 2024. Patients were classified into underweight (&lt;18.5 kg\/m<jats:sup>2<\/jats:sup>), normal weight (18.5\u201325.0 kg\/m<jats:sup>2<\/jats:sup>), and overweight (\u226525.0 kg\/m<jats:sup>2<\/jats:sup>) groups based on BMI categories. Meta-analysis was performed using a random-effects model. Additionally, exploratory sensitivity and subgroup analyses were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Twenty-two studies involving 41,144 patients with gastric cancer were included for quantitative analysis. Preoperative underweight (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03\u20131.55; <jats:italic>P<\/jats:italic> = 0.024) and overweight (OR: 1.19; 95%CI: 1.09\u20131.30; <jats:italic>P<\/jats:italic> &lt;0.001) were associated with an increased risk of postoperative complications. Furthermore, preoperative underweight was associated with poorer overall survival (hazard ratio [HR]: 1.40; 95%CI: 1.28\u20131.53; <jats:italic>P<\/jats:italic> &lt;0.001), whereas preoperative overweight was associated with better over-survival (HR: 0.82; 95%CI: 0.73\u20130.91; <jats:italic>P<\/jats:italic> &lt;0.001). Furthermore, preoperative underweight was not associated with disease-free survival (HR: 1.48; 95%CI: 0.97\u20132.26; <jats:italic>P<\/jats:italic> = 0.069), whereas preoperative overweight was associated with longer disease-free survival (HR: 0.80; 95%CI: 0.70\u20130.91; <jats:italic>P<\/jats:italic> = 0.001). In terms of specific postoperative complications, preoperative underweight was associated with an increased risk of septic shock (OR: 3.40; 95%CI: 1.26\u20139.17; <jats:italic>P<\/jats:italic> = 0.015) and a reduced risk of fever (OR: 0.39; 95%CI: 0.18\u20130.83; <jats:italic>P<\/jats:italic> = 0.014). Preoperative overweight was associated with an increased risk of wound infections (OR: 1.78; 95%CI: 1.08\u20132.93; <jats:italic>P<\/jats:italic> = 0.023), intestinal fistula (OR: 5.23; 95%CI: 1.93\u201314.21; <jats:italic>P<\/jats:italic> = 0.001), arrhythmia (OR: 6.38; 95%CI: 1.70\u201324.01; <jats:italic>P<\/jats:italic> = 0.006), and pancreatic fistula (OR: 3.37; 95%CI: 1.14\u20139.96; <jats:italic>P<\/jats:italic> = 0.028).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study revealed that both preoperative underweight and overweight status were associated with an increased risk of postoperative complications. Moreover, the postoperative survival outcomes were significantly better in overweight compared to that of underweight patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p><jats:bold>Registration:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/inplasy.com\/inplasy-2024-8-0004\/\" xlink:type=\"simple\">INPLASY202480004<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317985","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T18:49:24Z","timestamp":1738090164000},"page":"e0317985","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of preoperative body mass index with postoperative complications and survival for patients with gastric cancer: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5056-2952","authenticated-orcid":true,"given":"Zhenzhen","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanlu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"issue":"3","key":"pone.0317985.ref001","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"9","key":"pone.0317985.ref002","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1136\/gutjnl-2020-321600","article-title":"Global burden of oesophageal and gastric cancer by histology and subsite in 2018","volume":"69","author":"M Arnold","year":"2020","journal-title":"Gut"},{"issue":"10251","key":"pone.0317985.ref003","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S0140-6736(20)31288-5","article-title":"Gastric cancer","volume":"396","author":"EC Smyth","year":"2020","journal-title":"Lancet"},{"issue":"3","key":"pone.0317985.ref004","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.cgh.2019.07.045","article-title":"Burden of Gastric Cancer","volume":"18","author":"AP Thrift","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"pone.0317985.ref005","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"F Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0317985.ref006","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/bjs.6865","article-title":"Faivre J; EUROCARE working group. 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