Is laparoscopic colorectal cancer surgery associated with an increased risk in obese patients? A retrospective study from China

Abstract

BackgroundThe impact of obesity on surgical outcomes after laparoscopic colorectal cancer resection in Chinese patients is still unclear.MethodsWe retrospectively reviewed the prospectively collected data from 527 consecutive colorectal cancer patients who under went laparoscopic resection from January 2008 to September 2013. Patients were categorized into three groups: nonobese (body mass index (BMI) <25.0 kg/m2), obese I (BMI 25.0 = to 29.9 kg/m2) and obese II (BMI ≥30.0 kg/m2). Clinical characteristics, surgical outcomes and postoperative complications were compared between nonobese, obese I and obese II patients.ResultsFrom among the 527 patients, there were 371 patients with in the nonobese group, 142 patients in the obese I group and 14 patients in the obese II group. The patients were well-matched for age, sex and American Society of Anesthesiologists class, except for BMI (P = 0.001). The median operative time correlated highly significantly with increasing weight (median: nonobese = 135 minutes, obese I = 145 minutes, obese II = 162.5 minutes; P = 0.001). There appeared to be a slight tendency toward grade III complications (rated according to the Clavien-Dindo Classification of Surgical Complications) in the obese II group, but this difference was not significant (nonobese = 5.1%, obese I = 3.5% and obese II = 14.3%; P = 0.178). None of the grade III complications which occurred in the obese II group were wound dehiscences that required a stitch. Other aspects, such as estimated blood loss, harvested lymph nodes, operation type, pathological results, conversion rate and overall postoperative complications, were not statistically significant.ConclusionWith sufficient experience, laparoscopic colorectal cancer surgery is feasible and safe in obese Chinese patients.

Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta‐analysis

“…Five studies were retrospective, single centre studies that only included elective patients, leaving one prospective multicentre study, the DISCOVER study (Table ). Of the four studies reporting outcomes in patients undergoing surgery for malignancy (Table ), only the DISCOVER study found obesity to be an independent risk factor on multivariate analysis for major complications , with the other three studies finding no association . Only the DISCOVER study reported outcomes in the sub‐group of patients undergoing surgery for benign indications, finding no relationship between obesity and major complications.…”

“…A total of six studies [2,[17][18][19][20][21] were identified in the systematic review that presented primary data comparing major postoperative complications between healthy weight vs overweight and obese patients following gastrointestinal surgery (Fig. 2).…”

Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

“…Overall operative time was included in the majority of studies and was the only reported outcome that was associated with obesity in a majority of publications (Table ) . Among the 70 studies that included operative time as an outcome metric, 42 (60%) reported that obesity was associated with a longer operative time …”

“…A subset analysis was performed that examined SSI data among patients with colorectal cancer relative to surgical approach. Among the 54 studies on colorectal cancer, 16 included data on minimally invasive techniques . Among these 16 studies, 3 did not evaluate SSI .…”

“…Among these 16 studies, 3 did not evaluate SSI . Among the other 13 studies of patients with colorectal cancer who underwent a laparoscopic resection, 10 (76.9%) reported no difference in the incidence of SSI among obese and non‐obese patients . Similarly, there was no difference in the incidence of SSI among patients who underwent an open resection.…”