The association between body mass index and postoperative complications, 30-day mortality and long-term survival in Dutch patients with colorectal cancer

Arkenbosch, Jeanine; Erning, Felice N. van; Rutten, H.J.T.; Zimmerman, D. D. E.; Wilt, Johannes H. W. de; Beijer, Sandra

doi:10.1016/j.ejso.2018.09.012

Cited by 22 publications

(22 citation statements)

References 27 publications

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“…Recent studies focusing on BMI have found that underweight patients are more likely to have postoperative complications after CRC surgery than patients with normal weight. 31 , 32 Remarkably, this was not observed in the present study population and could be explained by the low numbers of patients with underweight (3.0% had a BMI <20) in a relatively healthy study population (87.2% were classified as ASA I–II). This might be explained by the fact that only patients who underwent elective surgery were included in the COLON study, which could have resulted in the exclusion of underweight patients with more advanced disease and worse clinical conditions.…”

Section: Discussioncontrasting

confidence: 66%

The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer

Loogman

Nes

Heil

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Research has demonstrated a possible relation between patients’ preoperative lifestyle and postoperative complications. OBJECTIVE: This study aimed to assess associations between modifiable preoperative lifestyle factors and postoperative complications in patients undergoing elective surgery for colorectal cancer. DESIGN: This is a retrospective study of a prospectively maintained database. SETTING: At diagnosis, data on smoking habits, alcohol consumption, BMI, and physical activity were collected by using questionnaires. Postoperative data were gathered from the nationwide database of the Dutch ColoRectal Audit. PATIENTS: Patients (n = 1564) with newly diagnosed stage I to IV colorectal cancer from 11 Dutch hospitals were included in a prospective observational cohort study (COLON) between 2010 and 2018. MAIN OUTCOME MEASURES: Multivariable logistic regression models were used to identify which preoperative lifestyle factors were associated with postoperative complications. RESULTS: Postoperative complications occurred in 28.5%, resulting in a substantially prolonged hospital stay (12 vs 5 days, p < 0.001). Independently associated with higher postoperative complication rates were ASA class II (OR, 1.46; 95% CI, 1.05–2.04; p = 0.03) and III to IV (OR, 3.17; 95% CI, 1.96–5.12; p < 0.001), current smoking (OR, 1.62; 95% CI, 1.02–2.56; p = 0.04), and rectal tumors (OR, 1.81; 95%CI, 1.28–2.55; p = 0.001). Body mass index, alcohol consumption, and physical activity did not show an association with postoperative complications. However, in a subgroup analysis of 200 patients with ASA III to IV, preoperative high physical activity was associated with fewer postoperative complications (OR, 0.17; 95% CI, 0.03–0.87; p = 0.04). LIMITATIONS: Compared with most studied colorectal cancer populations, this study describes a relatively healthy study population with 87.2% of the included patients classified as ASA I to II. CONCLUSIONS: Modifiable lifestyle factors such as current smoking and physical activity are associated with postoperative complications after colorectal cancer surgery. Current smoking is associated with an increased risk of postoperative complications in the overall study population, whereas preoperative high physical activity is only associated with a reduced risk of postoperative complications in patients with ASA III to IV. See Video Abstract at http://links.lww.com/DCR/B632 . LA ASOCIACIÓN ENTRE FACTORES MODIFICABLES DEL ESTILO DE VIDA Y COMPLICACIONES POSOPERATORIAS EN CIRUGÍA ELECTIVA EN PACIENTES CON CÁNCER COLORECTAL ...

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Section: Discussioncontrasting

confidence: 66%

The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer

Loogman

Nes

Heil

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…Taking into consideration that blood concentration of LEP correlates positively and ADP negatively with FM and BMI [16,30], we can indirectly support our outcomes using the abovecited study by Spychalski et al [10], in which BMI categories are not statistically significant predictors of risk of death in CRC patients. In a study by Arkenbosch et al [54], obesity in stage IV CRC patients was associated with improved survival compared to patients of normal weight and, in a study by Baastrup et al [55], visceral obesity was associated with an increased risk of conversion of laparoscopic rectal cancer resection to open surgery, but there was no association with the risk of perioperative complications. In another study, Adamová and Bár [11] reported that overweight CRC patients, when compared to those of normal weight and those who were obese, had the lowest incidence of complications and anastomotic leaks and the shortest length of stay after surgery (a Ushaped relationship).…”

Section: Discussionmentioning

confidence: 98%

Circulating Leptin, Adiponectin, and Tumor Necrosis Factor-Alpha in Patients Undergoing Surgery Due to Colorectal Cancer

et al. 2019

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Background: Adipocytokines have been proposed as factors mediating associations between obesity and inflammation in patients with colorectal cancer (CRC). Thus, the aim of this study was to determine the clinical relationships between blood concentrations of leptin (LEP), adiponectin (ADP), and tumor necrosis factor alpha (TNF-alpha) and the outcomes measured in patients with CRC undergoing surgery. Patients and Methods: History, body composition, and blood concentrations of LEP, ADP, and TNF-alpha were determined in 107 patients undergoing surgery due to CRC. The patients were followed up for 619.72 ± 371.65 days. Results: Compared to patients with stage II CRC, individuals with clinical stage I CRC had significantly lower ADP and higher TNF-alpha blood concentrations. We found significant correlations between the clinical stage of CRC (early vs. localized vs. metastatic) and the following: crude blood ADP concentration (R = 0.25; p = 0.015), ADP-to-TNF-alpha ratio (R = 0.31; p = 0.002), and ADP when indexed to body surface area (R = 0.25; p = 0.008) and to fat mass (R = 0.25; p = 0.016). The risk of death during the long-term follow-up period was independently related to the clinical stage of CRC, impairment of the patient’s functional status, and higher blood carcinoembryonic antigen concentration. In Kaplan-Meier survival analysis, patients with blood LEP concentrations adjusted to a visceral adipose tissue score of ≥0.47 had a significantly better likelihood of surviving than their counterparts. Conclusions: In patients with CRC undergoing surgery, blood ADP and TNF-alpha concentrations were associated with the clinical stage of the cancer, likelihood of radical tumor excision, occurrence of nonsurgical postoperative complications, and long-term survival, which suggests the role of dysregulation in the endocrine function of adipose tissue in response to the neoplasmatic process.

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“…There are limits to studies that have reported high BMI negatively affect AL, because they classified BMI into simply normal and high. Recent studies which classified BMI into low, normal, and high have reported different results that low BMI increases early complications after colorectal surgery compared to normal or high BMI [26,27]. There should be additional studies because effect of BMI on surgical outcome seems to have complex correlation with some metabolism-associated variables such as nutrition [27] or sarcopenia [28].…”

Section: Discussionmentioning

confidence: 99%

The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Cho

Lee

et al. 2021

Ann Surg Treat Res

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Anastomotic leak (AL) is defined as communication between intra-and extraluminal compartments caused by a defect in intestinal wall integrity at the anastomosis [1]. AL after colorectal surgery is one of the most dreadful complications because it can cause septic complications due to intraabdominal contamination from fecal content and may require reoperation often followed by creating a stoma [2,3]. In addition, AL after cancer surgery is known to increase locoregional recurrence and decrease survival rate [4,5].Despite the development of novel surgical techniques and instruments, the incidence rate of AL has not declined in recent decades [6]. According to previous research that analyzed the results of rectal cancer surgeries from 1990 to 2008 in 84 prospective cohort studies, the AL rate was approximately 11% and remains considerably high [2]. Therefore, studies aimed at reducing AL are of ongoing interest, and the 2 most common

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The association between body mass index and postoperative complications, 30-day mortality and long-term survival in Dutch patients with colorectal cancer

Cited by 22 publications

References 27 publications

The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer

The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer

Circulating Leptin, Adiponectin, and Tumor Necrosis Factor-Alpha in Patients Undergoing Surgery Due to Colorectal Cancer

The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

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