Influence of Visceral Fat in the Outcomes of Colorectal Cancer

Abstract

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.

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

“…Some authors found that the measurement of visceral fat on CT scan examination is a more sensitive factor than body mass index (BMI) to predict development of anastomotic dehiscence [ 44 , 45 ]. Goulart et al showed a direct relationship between visceral fat and anastomotic leakage and reoperation [ 46 ]. A meta-analysis evaluating visceral fat in patients with laparoscopic colorectal surgery revealed that visceral obesity was associated with longer operative time, less lymph nodes harvested, more conversion to open procedure, higher morbidity, more surgical site infection and more anastomotic leakage [ 47 ].…”

Impact of Visceral Fat on Survival and Metastasis of Stage III Colorectal Cancer

“…However, most studies have focused on the risk of complications after surgery, rather than recurrence or survival of CRC patients. [13][14][15][16] A few studies have shown the oncologic outcomes of CRC in viscerally obese patients; however, the results and conclusions of such studies vary. Some studies have shown that VO is related to poor progression-free survival and poor response to adjuvant chemotherapy [17][18][19] while other studies have argued that there is no convincing relationship between VO and survival or tumor stage of CRC.…”

Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a retrospective study

“…A case-matched study 20 has concluded that IIA in patients with obesity (BMI > 30kg/m 2 ) was associated with similar short-term outcomes and lower incidence of incisional hernias, and may possibly reduce the risk of hospital readmission. However, some published studies [21][22][23][24] show that obesity is associated with postoperative complications, anastomotic leakage and re-operation. A negative in uence of visceral fat on lymph nodes harvested was observed in patients with colorectal cancer 22 .…”

“…However, some published studies [21][22][23][24] show that obesity is associated with postoperative complications, anastomotic leakage and re-operation. A negative in uence of visceral fat on lymph nodes harvested was observed in patients with colorectal cancer 22 . In our subgroup analysis of patients with BMI ≥ 24 kg/m 2 , there was no signi cant difference found in rate or severity of postoperative complications in the two groups.…”