Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat

Sugisawa, Norihiko; Tokunaga, Masanori; Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Terashima, Masanori

doi:10.1007/s10120-011-0099-0

Cited by 59 publications

(44 citation statements)

References 35 publications

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“…This negative influence might account for the high risks of complications such as incision infection, leakage, postoperative pneumonia, and intra‐abdominal abscess . In contrast, although BMI routinely serves as an obesity index, the visceral fat area (VFA) is reportedly a more appropriate predictor of complications . Notably, VFA is often used as an obesity index for patients developing pancreatic fistula as a specific complication after gastrectomy, and an increase in VFA can serve as an important indicator of pancreatic fluid leakage risk …”

Section: Gastric Cancer Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

156

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In recent years, both the actual number of overweight/obese individuals and their proportion of the population have steadily been rising worldwide and obesity‐related diseases have become major health concerns. In addition, as obesity is associated with an increased incidence of gastroenterological cancer, the number of obese patients has also been increasing in the field of gastroenterological surgery. While the influence of obesity on gastroenterological surgery has been widely studied, very few reports have focused on individual organs or surgical procedures, using a cross‐sectional study design. In the present review, we aimed to summarize the impacts of obesity on surgeries for the esophagus, stomach, colorectum, liver and pancreas. In general, obesity prolongs operative time. As to short‐term postoperative outcomes, obesity might be a risk for certain complications, depending on the procedure carried out. In contrast, it is possible that obesity doesn't adversely impact long‐term surgical outcomes. The influences of obesity on surgery are made even more complex by various categories of operative outcomes, surgical procedures, and differences in obesity among races. Therefore, it is important to appropriately evaluate perioperative risk factors, including obesity.

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Section: Gastric Cancer Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

156

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“…High BMI has been correlated with adverse surgical outcomes in several fields including urological, hepatobiliary and gastrointestinal surgery [6,7,16,17]. Studies on CD such as Causey's study of 2,319 CD patients undergoing abdominal operations have also associated obesity with increased morbidity [10].…”

Section: Discussionmentioning

confidence: 99%

Volumetric Fat Ratio and Not Body Mass Index Is Predictive of Ileocolectomy Outcomes in Crohn's Disease Patients

Connelly

Juza²,

Sangster³

et al. 2014

Dig Surg

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Background: Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD. Methods: One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry. Patient demographics and operative outcomes were recorded. Visceral (VA) and subcutaneous (SA) adiposity and abdominal circumference (AC) were analyzed on preoperative CT scans using Aquarius iNtuition software. A visceral/subcutaneous ratio (VSR) was calculated. Results: BMI correlated with SA (p = 0.0001), VA (p = 0.0001) and AC (p = 0.0001) but not VSR (p > 0.05). BMI, VA and AC did not predict surgical morbidity (p > 0.05). In multivariate regression analysis, family history of IBD (p = 0.009), high American Society of Anesthesiologists score (p = 0.02) and increased VSR (p = 0.03) were independent predictors of postoperative morbidity. Conclusions: The visceral/subcutaneous fat ratio is a more reliable predictor of postoperative outcomes in CD patients undergoing ileocolectomy than conventional adiposity markers such as BMI. Preoperative calculation of the visceral/subcutaneous fat ratio offers the opportunity to optimize high-risk surgical patients, thus improving outcomes.

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“…D2 surgery is a safe procedure in Japan; however, it sometimes leads to lethal complications. Several factors, such as older age, the American Society of Anesthesiologists (ASA) score, obesity (body mass index C25), higher visceral fat area, and multiple comorbidities have previously been identified as risk factors for gastric cancer surgery [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

et al. 2015

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Background Sarcopenia is a decrease in both muscle mass and strength. It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery. This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery. Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined. Patients with performance status 3 or 4 were excluded. Preoperative lean body mass (LBM) was evaluated by bioelectrical impedance analysis and expressed as LBM index. Preoperative muscle function was measured by hand grip strength (HGS). The cutoff values were the gender-specific lowest 20 %. Grade 2 or higher morbidities, as retrospectively evaluated by the Clavien-Dindo classification, were obtained from the patient record. The risk factors for morbidity were examined by univariate and multivariate analyses. Results Morbidity was observed in 39 patients (13.3 %), including 7 with pancreatic leakage, 12 with anastomotic leakage, and 4 with intraabdominal abscesses, but no mortality was observed. The univariate analysis showed that male gender, total gastrectomy, splenectomy, and a low HGS were significant risk factors for morbidity. A low LBM was not a significant risk factor. A low HGS, male gender, and total gastrectomy remained significant in the multivariate analysis. Conclusions A low hand grip strength was a significant risk factor for morbidity after gastric cancer surgery. The importance of the hand grip strength as a risk factor should be examined in future prospective studies.

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Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat

Abstract: Excessive visceral fat, represented by the VFA, was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage following gastrectomy.

Cited by 59 publications

References 35 publications

Obesity as a surgical risk factor

Obesity as a surgical risk factor

Volumetric Fat Ratio and Not Body Mass Index Is Predictive of Ileocolectomy Outcomes in Crohn's Disease Patients

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

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