Skip to main content
Log in

Visceral Obesity Predicts Surgical Outcomes after Laparoscopic Colectomy for Sigmoid Colon Cancer

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

This study was designed to assess whether visceral obesity is a more useful predictor of surgical outcomes compared with body mass index after laparoscopic colectomy.

Methods

A total of 133 consecutive patients who underwent elective laparoscopic colectomy for sigmoid colon cancer between April 2001 and April 2007 were included. Obesity was defined by visceral fat area ≥130 cm2 or body mass index ≥25 kg/m2, and the variables were compared for obese and nonobese patients.

Results

There were 68 (51.1 percent) obese patients according to visceral fat area and 27 (20.3 percent) according to body mass index. Using either definition, obese patients had a significantly longer operative time compared with nonobese patients. Patients classified as obese by visceral fat area had a significantly higher incidence of wound infection (20.6 vs. 4.6 percent; P = 0.006) and overall complication rates (32.4 vs. 12.3 percent, P = 0.006) compared with nonobese patients, whereas there was no significant difference when classified by body mass index. Postoperative hospital stay was significantly longer in obese patients compared with nonobese patients classified by visceral fat area (median 10.5 vs. 9 days; P = 0.007), whereas it was not statistically different when classified by body mass index.

Conclusion

Visceral fat area is a more useful parameter than body mass index in predicting surgical outcomes after laparoscopic colectomy for sigmoid colon cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIGURE 1
FIGURE 2
FIGURE 3

Similar content being viewed by others

References

  1. Pikarsky AJ, Saida Y, Yamaguchi T, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 2002;16:855–8.

    Article  PubMed  CAS  Google Scholar 

  2. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 2003;7:558–61.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  4. Dostalik J, Martinek L, Vavra P, Andel P, Gunka I, Gunkova P. Laparoscopic colorectal surgery in obese patients. Obes Surg 2005;15:1328–31.

    Article  PubMed  Google Scholar 

  5. Schwandner O, Farke S, Schiedeck TH, Bruch HP. Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 2004;18:1452–6.

    Article  PubMed  CAS  Google Scholar 

  6. Delaney CP, Pokala N, Senagore AJ, et al. Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum 2005;48:975–81.

    Article  PubMed  Google Scholar 

  7. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157–63.

    Article  Google Scholar 

  8. Després JP. Is visceral obesity the cause of the metabolic syndrome? Ann Med 2006;38:52–63.

    Article  PubMed  Google Scholar 

  9. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature 2006;444:881–7.

    Article  PubMed  Google Scholar 

  10. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000;21:697–738.

    Article  PubMed  CAS  Google Scholar 

  11. Seki Y, Ohue M, Sekimoto M, et al. 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 2007;21:929–34.

    Article  PubMed  CAS  Google Scholar 

  12. Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M. Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 2005;92:1261–2.

    Article  PubMed  CAS  Google Scholar 

  13. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–78.

    Article  PubMed  CAS  Google Scholar 

  14. Kvist H, Chowdhury B, Sjostrom L, Tylen U, Cederblad A. Adipose tissue volume determination in males by computed tomography and 40 K. Int J Obes 1988;12:249–66.

    PubMed  CAS  Google Scholar 

  15. The Examination Committee of Criteria for “Obesity Disease” in Japan. Japan Society for the Study of Obesity. New criteria for “obesity disease” in Japan. Circ J 2002;66:987–92.

    Article  Google Scholar 

  16. Ribeiro-Filho FF, Faria AN, Azjen S, Zanella MT, Ferreira SR. Methods of estimation of visceral fat: advantages of ultrasonography. Obes Res 2003;11:1488–94.

    Article  PubMed  Google Scholar 

  17. Sass DA, Schoen RE, Weissfeld JL, et al. Relationship of visceral adipose tissue to recurrence of adenomatous polyps. Am J Gastroenterol 2004;99:687–93.

    Article  PubMed  Google Scholar 

  18. von Eyben FE, Mouritsen E, Holm J, et al. Intra-abdominal obesity and metabolic risk factors: a study of young adults. Int J Obes Relat Metab Disord 2003;27:941–9.

    Article  Google Scholar 

  19. Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology 1999;211:283–6.

    PubMed  CAS  Google Scholar 

  20. Goodpaster BH, Kelley DE, Wing RR, Meier A, Thaete FL. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999;48:839–47.

    Article  PubMed  CAS  Google Scholar 

  21. Hunter GR, Snyder SW, Kekes-Szabo T, Nicholson C, Berland L. Intra-abdominal adipose tissue values associated with risk of possessing elevated blood lipids and blood pressure. Obes Res 1994;2:563–8.

    PubMed  CAS  Google Scholar 

  22. Park HS, Lee K. Greater beneficial effects of visceral fat reduction compared with subcutaneous fat reduction on parameters of the metabolic syndrome: a study of weight reduction programmes in subjects with visceral and subcutaneous obesity. Diabet Med 2005;22:266–72.

    Article  PubMed  CAS  Google Scholar 

  23. Rössner S, Bo WJ, Hiltbrandt E, et al. Adipose tissue determinations in cadavers: a comparison between cross-sectional planimetry and computed tomography. Int J Obes 1990;14:893–902.

    PubMed  Google Scholar 

  24. Després JP, Lamarche B. Effects of diet and physical activity on adiposity and body fat distribution: implications for the prevention of cardiovascular disease. Nutr Res Rev 1993;6:137–59.

    Article  Google Scholar 

  25. Inoue M, Sobue T, Tsugane S. Impact of body mass index on the risk of total cancer incidence and mortality among middle-aged Japanese: data from a large-scale population-based cohort study—the JPHC study. Cancer Causes Control 2004;15:671–80.

    Article  PubMed  Google Scholar 

  26. Yoshiike N, Seino F, Tajima S, et al. Twenty-year changes in the prevalence of overweight in Japanese adults: the National Nutrition Survey 1976–95. Obes Rev 2002;3:183–90.

    Article  PubMed  CAS  Google Scholar 

  27. WHO/IASO/IOTF. The Asia-Pacific Perspective. Redefining obesity and its treatment. Australia: Health Communications Australia Pty Ltd, 2000. (WWW document.) ISBN #0-9577082-1-1. (full document available at: http//www.idi.org.au/obesity_report.htm)

  28. Anuurad E, Shiwaku K, Nogi A, et al. The new BMI criteria for Asians by the regional office for the Western Pacific Region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health 2003;45:335–43.

    Article  PubMed  Google Scholar 

  29. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987–1003.

    Article  PubMed  CAS  Google Scholar 

  30. Hirooka M, Kumagi T, Kurose K, et al. A technique for the measurement of visceral fat by ultrasonography: comparison of measurements by ultrasonography and computed tomography. Intern Med 2005;44:794–9.

    Article  PubMed  Google Scholar 

  31. Ross R, Dagnone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 2000;133:92–103.

    PubMed  CAS  Google Scholar 

References

  1. Kabon B, Nagele A, Reddy D, et al. Obesity decreases perioperative tissue oxygenation. Anesthesiology 2004;100:274–80.

    Article  PubMed  Google Scholar 

  2. Fleischmann E, Kurz A, Niedermayr M, et al. Tissue oxygenation in obese and non-obese patients during laparoscopy. Obes Surg 2005;15:813–9.

    Article  PubMed  Google Scholar 

  3. Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 2007;50:2223–37.

    Article  PubMed  Google Scholar 

  4. House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg 2008;12:270–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Tsujinaka, S., Konishi, F., Kawamura, Y.J. et al. Visceral Obesity Predicts Surgical Outcomes after Laparoscopic Colectomy for Sigmoid Colon Cancer. Dis Colon Rectum 51, 1757–1767 (2008). https://doi.org/10.1007/s10350-008-9395-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-008-9395-0

Key words

Navigation