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Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index

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Abstract

Background

The aim of this study was to evaluate the impact of visceral fat obesity (VFO) on early surgical and oncologic outcomes of laparoscopic total mesorectal excision (LTME) for rectal cancer.

Patients and Methods

Between June 2003 and June 2009, a total of 142 patients who had undergone LTME were included. Patients were divided into the obese group (OG) and the non-obese group (NOG) according to BMI and visceral fat area (VFA). Obesity was defined by BMI ≥25 kg/m² or VFA ≥130 cm².

Results

There were 37 (26.0%) and 29 (20.4%) obese patients according to BMI and VFA, respectively. The OG, defined by both VFA and BMI, had a significantly longer operative time. The VFO group experienced more frequent conversion to laparotomy (17.2% vs. 5.0%; P = 0.047) and significantly higher blood loss during surgery (205.8 ± 257.0 mL vs. 102.5 ± 219.9 mL; P = 0.031), whereas there was no significant difference when defined by BMI. Time to first flatus was significantly longer in the VFO group compared with the NOG (mean 3.5 days vs. 2.7 days; P = 0.046), whereas it was not significantly different when classified by BMI. Regarding oncologic parameters, the VFO group had a significantly higher number of patients from whom less than 12 total lymph nodes were retrieved (65.5% vs. 34.5%; P = 0.002); however, there was no difference between the two groups defined by BMI.

Conclusion

VFO is proven to be a more reliable predictive factor than BMI in estimating early surgical outcomes for patients who underwent LTME. VFO is associated with fewer numbers of retrieved lymph nodes.

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References

  1. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  3. Poon JT, Law WL (2009) Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol 16:3038–3047

    Article  PubMed  Google Scholar 

  4. Rottoli M, Bona S, Rosati R, Elmore U, Bianchi PP, Spinelli A et al (2009) Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival. Ann Surg Oncol 16:1279–1286

    Article  PubMed  Google Scholar 

  5. Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94:1548–1554

    Article  PubMed  CAS  Google Scholar 

  6. Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237

    Article  PubMed  Google Scholar 

  7. Bege T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero JR (2009) Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 23:1460–1464

    Article  PubMed  Google Scholar 

  8. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451

    Article  PubMed  CAS  Google Scholar 

  9. Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R et al (2000) Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 59:18–23

    Article  PubMed  CAS  Google Scholar 

  10. Gorog D, Nagy P, Peter A, Perner F (2003) Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res 9:180–183

    Article  PubMed  Google Scholar 

  11. Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241:69–76

    PubMed  Google Scholar 

  12. WHO expert consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  13. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K et al (2011) Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 364:719–729

    Article  PubMed  CAS  Google Scholar 

  14. Japan Society for the Study of Obesity (2002) New criteria for ‘obesity disease’ in Japan. Circ J 66:987–992

    Article  Google Scholar 

  15. Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M et al (2007) Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc 21:929–934

    Article  PubMed  CAS  Google Scholar 

  16. Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O et al (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1765, discussion 1765–1757

    Article  PubMed  Google Scholar 

  17. Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M (2005) Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 92:1261–1262

    Article  PubMed  CAS  Google Scholar 

  18. Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209:694–701

    Article  PubMed  Google Scholar 

  19. Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908

    Article  PubMed  CAS  Google Scholar 

  20. Sjostrom L, Kvist H, Cederblad A, Tylen U (1986) Determination of total adipose tissue and body fat in women by computed tomography, 40K, and tritium. Am J Physiol 250:E736–E745

    PubMed  CAS  Google Scholar 

  21. Kvist H, Chowdhury B, Sjostrom L, Tylen U, Cederblad A (1988) Adipose tissue volume determination in males by computed tomography and 40K. Int J Obes 12:249–266

    PubMed  CAS  Google Scholar 

  22. Yoshizumi T, Nakamura T, Yamane M, Islam AH, Menju M, Yamasaki K et al (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211:283–286

    PubMed  CAS  Google Scholar 

  23. Schwandner O, Farke S, Schiedeck TH, Bruch HP (2004) Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 18:1452–1456

    Article  PubMed  CAS  Google Scholar 

  24. Tuech JJ, Regenet N, Hennekinne S, Pessaux P, Bergamaschi R, Arnaud JP (2001) Laparoscopic colectomy for sigmoid diverticulitis in obese and nonobese patients: a prospective comparative study. Surg Endosc 15:1427–1430

    PubMed  CAS  Google Scholar 

  25. Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd et al (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163

    PubMed  CAS  Google Scholar 

  26. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  PubMed  Google Scholar 

  27. Mekenkamp LJ, van Krieken JH, Marijnen CA, van de Velde CJ, Nagtegaal ID (2009) Lymph node retrieval in rectal cancer is dependent on many factors—the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol 33:1547–1553

    Article  PubMed  Google Scholar 

  28. Cawthorn SJ, Gibbs NM, Marks CG (1986) Clearance technique for the detection of lymph nodes in colorectal cancer. Br J Surg 73:58–60

    Article  PubMed  CAS  Google Scholar 

  29. Kim CS, Lee SC, Kim YM, Kim BS, Choi HS, Kawada T et al (2008) Visceral fat accumulation induced by a high-fat diet causes the atrophy of mesenteric lymph nodes in obese mice. Obesity (Silver Spring) 16:1261–1269

    Article  CAS  Google Scholar 

  30. Hida J, Yoshifuji T, Tokoro T, Inoue K, Matsuzaki T, Okuno K et al (2004) Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 47:1578–1585

    Article  PubMed  Google Scholar 

  31. Liang JT, Lai HS, Lee PH, Huang KC (2007) Comparison of functional and surgical outcomes of laparoscopic-assisted colonic J-pouch versus straight reconstruction after total mesorectal excision for lower rectal cancer. Ann Surg Oncol 14:1972–1979

    Article  PubMed  Google Scholar 

  32. Dehni N, Tiret E, Singland JD, Cunningham C, Schlegel RD, Guiguet M et al (1998) Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch–anal anastomosis. Dis Colon Rectum 41:817–822, discussion 822–813

    Article  PubMed  CAS  Google Scholar 

  33. Wexner SD, Alabaz O (1998) Anastomotic integrity and function: role of the colonic J-pouch. Semin Surg Oncol 15:91–100

    Article  PubMed  CAS  Google Scholar 

  34. Yoshiike N, Matsumura Y, Zaman MM, Yamaguchi M (1998) Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990–1994. Int J Obes Relat Metab Disord 22:684–687

    Article  PubMed  CAS  Google Scholar 

  35. Tanaka K, Miyashiro I, Yano M, Kishi K, Motoori M, Seki Y et al (2009) Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy. Ann Surg Oncol 16:1520–1525

    Article  PubMed  Google Scholar 

  36. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A et al (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea, 120-752

    Jeonghyun Kang, Taehyung Kim, Hyuk Hur, Byung Soh Min, Nam Kyu Kim & Kang Young Lee

  2. Department of Diagnostic Radiology, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea

    Song-Ee Baek & Joon Seok Lim

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  1. Jeonghyun Kang
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  2. Song-Ee Baek
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Correspondence to Kang Young Lee.

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Kang, J., Baek, SE., Kim, T. et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Colorectal Dis 27, 497–505 (2012). https://doi.org/10.1007/s00384-011-1333-2

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