Impact of obesity on short-term results of laparoscopic rectal cancer resection

Bège, Thierry; Lelong, Bernard; Francon, Daniel; Turrini, Olivıer; Guiramand, Jérôme; Delpero, Jean‐Robert

doi:10.1007/s00464-008-0266-5

Cited by 98 publications

(133 citation statements)

References 23 publications

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“…There is also burgeoning evidence that laparoscopic colorectal surgery can be safely completed in the obese with conversion rates varying from 7.3-46%. 8,9 Thus, obesity itself should not be used as a reason not to offer laparoscopic surgery. Nonetheless, within the obese group, there are patients who are undoubtedly more challenging.…”

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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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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“…Some reports have demonstrated that obesity is associated with high conversion rates [16][17][18]. One of the difficulties of performing laparoscopic surgery on obese patients is obtaining good visualization of the surgical field.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…A French retrospective review of 210 mesorectal excisions, where most patients received neoadjuvant radiotherapy, found no difference in lymph node sampling (P ¼ .23) between obese (BMI >30) and nonobese. 46 Another retrospective analysis that included 254 patients with rectal adenocarcinoma stratified lymph node yield by BMI, with obesity defined by BMI >30. 47 Two thirds of the patients were treated with neoadjuvant radiotherapy and/or chemotherapy, and a minority of patients underwent laparoscopic resection (4% of obese, OBESITY AND COLORECTAL CANCER/GRIBOVSKAJA-RUPP ET AL 11% nonobese).…”

Section: Obesity and Colorectal Surgery Outcomesmentioning

confidence: 99%

“…56 Short-term morbidity for rectal cancer resection seems to be increased with obesity. In addition, obesity is reported to be significantly associated with rates of anastomotic leak, 57,58 parastomal hernia, 59 wound infection, 60,61 length of laparoscopic surgery according to BMI, [46][47][48]60 length of laparoscopic surgery according to visceral adipose area, 62,63 overall and systemic complications, 62 more frequent conversion to laparotomy, 46,64 more blood loss, 47,58,63 and longer hospital stay. 48 In addition, obese patients undergoing laparoscopic colorectal surgery are at an increased risk for conversion to open operation and operative times are significantly increased for obese patients having rectal cancer surgery.…”

Section: Obesity and Colorectal Surgery Outcomesmentioning

confidence: 99%

Obesity and Colorectal Cancer

Myung

2012

Korean J Gastroenterol

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Obesity is a risk factor for colorectal cancer based on its molecular and metabolic effects on insulin and IGF-1, leptin, adipocytokines, and sex hormones. Obese men have a higher risk of colorectal cancer compared with normal weight men, but the association between obesity and rectal cancer is weaker than with colon cancer. There is a weaker association between obesity and colon cancer in women than in men, and no appreciable association between obesity and rectal cancer in women. Although obesity does not seem to have an effect on the number of lymph nodes harvested with resection, obesity does seem to be associated with more-aggressive colorectal cancers in a handful of studies. Survival and local recurrence studies are contradictory with no conclusive evidence that obesity predisposes to worse overall survival or increased recurrence in colon and rectal cancers. The literature is not definitive as far as overall morbidity and mortality rates in the obese are concerned, though obese rectal cancer patients seem to incur proportionally more morbidity and mortality. Preexisting steatosis or steatohepatitis in obese colorectal cancer patients or chemotherapy-induced liver dysfunction may lead to an increased mortality in obese patients with colorectal liver metastases. Diabetes may cause poorer response to neoadjuvant therapy in rectal cancer and contribute to higher mortality and recurrence in colon cancer.KEYWORDS: Obesity, colon cancer, rectal cancer, diabetes, men, women Objectives: After reading this review, the reader should be able to summarize how and why obesity is a risk factor for colorectal cancer, and have an appreciation for how definitions of obesity vary and impact study results. In addition, the reader should also understand the impact of obesity on colorectal cancer short-term outcomes, long-term oncologic outcomes, and how obesity can impact the chemotherapeutic treatment of metastatic disease.Colorectal cancer (CRC) is a major cause of cancer death in Western societies and it is well known that this elevated risk is related to an imbalance between neoplasia promoting and protective dietary and lifestyle factors. Among the factors that tend to elevate risk are a high intake of animal fat, high calorie intake, high intake of processed foods with low fiber content, limited physical activity, excess alcohol intake, and finally obesity.What follows is a discussion on how and why obesity is a risk factor for colorectal cancer and how obesity influences short-and long-term oncologic outcomes from a surgical, pathologic, radiotherapy, and chemotherapeutic perspective. The data leads one to conclude that obesity has implications in all aspects of the care of colorectal cancer patients, from screening to surgical treatment to adjuvant or neoadjuvant treatments.

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Impact of obesity on short-term results of laparoscopic rectal cancer resection

Abstract: Obesity increases operative duration and conversion rate of rectal laparoscopic resection for cancer. Although obesity is associated with a worse preoperative evaluation, there is no increase in relevant morbidity and no impairment of oncological safety.

Cited by 98 publications

References 23 publications

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

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

Obesity and Colorectal Cancer

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