Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index

Kang, Jeonghyun; Baek, Song Ee; Kim, Tae-Hyung; Hur, Hyuk; Min, Byung Soh; Lim, Joon Seok; Kim, Nam Kyu; Lee, Kang Young

doi:10.1007/s00384-011-1333-2

Cited by 76 publications

(123 citation statements)

References 36 publications

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“…One of the reasons that explain part of this disagreement may be the different definitions of VF used in the articles published: VF area or volume [11, 14-17], ratio between VF and subcutaneous fat area [10], ratio between VF and total fat area [12] and ratio between VF and body surface area [9]. In addition, the same definition, like for example VF area, has different cut-off points in different papers [18].…”

Section: Discussionmentioning

confidence: 99%

“…Those guidelines recommend that less than 12 lymph nodes retrieved constitute the high-risk factors for recurrence and adjuvant chemotherapy is beneficial to those patients [23]. Some papers concluded that the number of nodes harvested from patients with higher VF was signiﬁcantly smaller [14, 17, 21] and others did not agree with this conclusion [10, 12]. This difference of lymph nodes harvested that we found on CC patients can have 2 explanations: VF increases surgical difficulty presenting as a problem for the surgeon to perform an accurate oncologic dissection and fat tissue adhering to the mesentery and makes the identification of the lymph nodes difficult for the pathologist [18].…”

Section: Discussionmentioning

confidence: 99%

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Influence of Visceral Fat in the Outcomes of Colorectal Cancer

et al. 2018

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Aim: To determine the relationship of visceral fat (VF) with the surgical outcome of the patients with colorectal cancer (CRC) submitted to curative surgery. Methods: Retrospective analysis of all patients submitted to CRC surgery during 3 years with a minimum of 5 years of follow-up. We assessed the length of hospital stay, complications, pathologic reports, surgical re-interventions and hospital re-admissions, relapses, survival time and disease-free time. VF was calculated based on patients’ pre-operative CT-scan. The patients were divided into quartiles according to the VF area. Linear regression models and logistic regression models were used to establish a relationship between VF and all data collected. Results: The study included 199 patients (129 with colon cancer [CC] and 70 with rectal cancer). The average area of VF was 115.7 cm². Patients with CRC revealed a direct relationship between VF and postoperative complications (p = 0.043), anastomotic leakage (p = 0.009) and re-operation (p = 0.005). The subgroup of patients with CC had an inverse association between VF and lymph nodes harvested (p = 0.027). Survival analyses did not reveal significant differences. Conclusion: VF has an influence on postoperative complications, anastomotic leakage and re-operation. A negative influence of VF on lymph nodes harvested was observed on CC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

et al. 2018

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“…Visceral obesity was calculated as visceral fat area on the basis of a CT scan using dedicated software to estimate the adipose area at one or more predefined levels. 11,18,19 In contrast to visceral fat area, AFR is a simple ratio that illustrates the relationship between anterior abdominal wall fat and intra-abdominal fat. The ratio itself uses an intraabdominal diameter at a given level (the level of the umbilicus) and is not an estimation of total intra-abdominal fat.…”

Section: Discussionmentioning

confidence: 99%

Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

Farid

Mann

et al. 2017

annals

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INTRODUCTION Laparoscopic surgery has become the standard for colorectal cancer resection in the UK but it can be technically challenging in patients who are obese. Patients whose body fat is mainly inside the abdominal cavity are more challenging than those whose fat is mainly outside the abdominal cavity. Abdominal fat ratio (AFR) is a simple parameter proposed by the authors to aid identification of this subgroup. MATERIALS AND METHODS All 195 patients who underwent elective, laparoscopic colorectal cancer resections from March 2010 to November 2013 were included in the study. For patients who were obese (body mass index greater than 30), preoperative staging computed tomography was used to determine AFR. This was assessed by two different, blinded observers and compared with conversion rate. RESULTS Of the 195 patients, 58 (29.7%) fell into the obese group and 137 (70.3%) into the non-obese group. The median AFR of the obese group that were converted to open surgery was significantly higher at 5.9 compared with those completed laparoscopically (3.3, P = 0.0001, Mann-Whitney). There was no significant difference in conversion rate when looking at body mass index, tumour site or size. DISCUSSION Previous studies have found body mass index, age, gender, previous abdominal surgery, site and locally advanced tumours to be associated with an increased risk of conversion. This study adds AFR to the list of risk factors. CONCLUSION AFR is a simple, reproducible parameter which can help to predict conversion risk in obese patients undergoing colorectal cancer resection.

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“…Using CT scan assessments of visceral fat to define obesity, Ishii et al reported a significant increase in the duration of surgery and morbidity rate in visceral obese patients [21]. Kang et al [22] reported that the visceral fat area measured by CT could be used as a more accurate predictor of surgical complexity than BMI. Therefore, the BMI may not be an accurate estimate of visceral fat.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Body Mass Index on Perioperative Outcomes After Laparoscopic Colorectal Surgery

et al. 2014

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Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index

Abstract: VFO is proven to be a more reliable predictive factor than BMI in estimating early surgical outcomes for patients who underwent LTME. VFO is associated with fewer numbers of retrieved lymph nodes.

Cited by 76 publications

References 36 publications

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

Influence of Visceral Fat in the Outcomes of Colorectal Cancer

Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

The Impact of Body Mass Index on Perioperative Outcomes After Laparoscopic Colorectal Surgery

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