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Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Obesity is an established risk factor for colorectal cancer, particularly in males, and may negatively impact on oncologic outcomes. The aim of this study was to examine the impact of body mass index (BMI) on mortality and morbidity, tumour pathology, and overall survival in a consecutive cohort of Irish colorectal cancer patients treated with curative intent.

Methods

A retrospective analysis of BMI data entered prospectively into a comprehensive electronic database of colorectal cancer patients was undertaken. Patients were excluded if they had emergency surgery, previous malignancy or the BMI was not recorded. Analysis was performed comparing genders, obese with non-obese and comparing BMI categories.

Results

Of the 414 patients, 10% were underweight (<20 kg/m2); 35% were normal weight (20–25 kg/m2); 37% were overweight (25–30 kg/m2), and 18% were obese (≥30.00 kg/m2). Obesity overall was not significantly associated with pathological stage (p = 0.099) or positive lymph node status (p = 0.109) or degree of nodal involvement (p = 0.068). Obesity was significantly (p<0.05) associated with more advanced pathological stage, node positivity and degree of nodal involvement in male only and colon cancer only analysis. There was no difference in the overall incidence of major (p = 0.244) and minor complications (p = 0.078) when comparing obese with non-obese, but pelvic abscesses were more common in obese patients (p = 0.037). The underweight cohort had a higher rate of major complications (p = 0.041), sepsis (p = 0.024) and post-operative death (p = 0.006). Survival was equivalent between BMI categories and obese and non-obese groups (p = 0.469).

Conclusion

Obesity was associated with more advanced tumours in males and in colon cancer patients only and with a higher risk of post-operative pelvic abscesses but no significant differences with non-obese cohorts in the main outcome measures of in-hospital mortality, major morbidity and survival. Conversely, the adverse consequences of under-nutrition were highlighted in this study.

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Abbreviations

BMI:

Body mass index

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

ASA:

American Society of Anaesthesiologists

ARDS:

Acute respiratory distress syndrome

SPSS:

Statistical Package for the Social Sciences

References

  1. Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O'Connell MJ et al (2006) Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 98:1647–1654

    Article  PubMed  Google Scholar 

  2. National Cancer Registry Ireland. Trend in Irish cancer incidence 1994–2002: with projections to 2020 (2006). Available at: http://www.ncri.ie/pubs/pubfiles/proj_2020.pdf. Accessed on: 01 October 2009.

  3. Benoist S, Panis Y, Alves A, Valleur P (2000) Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 179:275–281

    Article  CAS  PubMed  Google Scholar 

  4. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  PubMed  Google Scholar 

  5. Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB 3rd, Macdonald JS et al (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98:484–495

    Article  PubMed  Google Scholar 

  6. Murphy TK, Calle EE, Rodriguez C, Kahn HS, Thun MJ (2000) Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 152:847–854

    Article  CAS  PubMed  Google Scholar 

  7. Tsukada K, Miyazaki T, Kato H, Masuda N, Fukuchi M, Fukai Y et al (2004) Body fat accumulation and postoperative complications after abdominal surgery. Am Surg 70:347–351

    PubMed  Google Scholar 

  8. Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O, Lefor AT (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51(12):1757–1767

    Article  PubMed  Google Scholar 

  9. Trevisan M, Liu J, Muti P et al (2001) Markers of insulin resistance and colorectal cancer mortality. Cancer Epidemiol Biomark Prev 10:937–941

    CAS  Google Scholar 

  10. Cholangelo LA, Gapstur SM, Gann PH et al (2002) Colorectal cancer mortality and factors related to the insulin resistance syndrome. Cancer Epidemiol Biomark Prev 11:385–391

    Google Scholar 

  11. Karnofsky DA, Burchenal JH (1949). The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed), Evaluation of chemotherapeutic agents. Columbia Univ Press pp. 196

  12. Oken MM, Creech RH, Tromey DC, Horton J, Davis TE, McFadden ET et al (1982) Toxicity and response criteria of the Eastern Cooperative Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  13. American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  14. Strul H, Kariv R, Leshno M, Halak A, Jakubowicz M, Santo M, Umansky M, Shirin H, Degani Y, Revivo M, Halpern Z, Arber N (2006) The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40–80 years. Am J Gastroenterol 101(2):255–262

    Article  PubMed  Google Scholar 

  15. World Health Organization Consultation on Obesity (1998) Preventing and managing the global epidemic: report of a WHO consultation on Obesity, Geneva, 3–5 June 1997, 1–276. World Health Organization, Geneva

    Google Scholar 

  16. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG (2002) AJCC cancer staging manual, 6th ed, 6th edn. Springer, New York

    Google Scholar 

  17. Turnbull RB, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166:420–427

    Article  PubMed  Google Scholar 

  18. Staib L, Link KH, Blatz A, Beger HG (2002) Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients monoinstitutional experience. World J Surg 26:59–66

    Article  PubMed  Google Scholar 

  19. Bokey EL, Chapuis PH, Fung C, Hughes WJ, Koorey SG, Brewer D, Newland RC (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38(5):480–487

    Article  CAS  PubMed  Google Scholar 

  20. Merkow RP, Bilimoria KY, McCarter MD, Bentrem DJ (2009) Effect of body mass index on short-term outcomes after colectomy for cancer. J Am Coll Surg 208(1):53–61

    Article  PubMed  Google Scholar 

  21. Huxley RR, Ansary-Moghaddam A, Clifton P, Czernichow S, Parr CL, Woodward M (2009) The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer 125(1):171–180

    Article  CAS  PubMed  Google Scholar 

  22. Frezza EE, Wachtel MS, Chiriva-Internati M (2006) Influence of obesity on the risk of developing colon cancer. Gut 55:285–291

    Article  CAS  PubMed  Google Scholar 

  23. Kim SE, Shim KN, Jung SA, Yoo K, Moon IH (2007) An association between obesity and the prevalence of colonic adenoma according to age and gender. J Gastroenterol 42:616–623

    Article  PubMed  Google Scholar 

  24. Schoen RE, Tangen CM, Kuller LH, Burke GL, Cushman M, Tracy RP, Dobs A, Savage PJ (1999) Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst 91:1147–1154

    Article  CAS  PubMed  Google Scholar 

  25. Pischon T, Lahmann PH, Boeing H et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98(13):920–931

    Article  PubMed  Google Scholar 

  26. Després JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444(14):881–887

    Article  PubMed  Google Scholar 

  27. Haydon AM, Macinnis RJ, English DR, Giles GG (2006) Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55(1):62–67

    Article  CAS  PubMed  Google Scholar 

  28. 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(6):433–441

    Article  PubMed  Google Scholar 

  29. Mullen JT, Moorman DW, Cavenport DL (2009) The obesity paradox body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250:166–172

    Article  PubMed  Google Scholar 

  30. Morgan K, McGee H, Watson D, Perry I, Barry M, Shelley E, Harrington J, Molcho M, Layte R, Tully N, van Lente E, Ward M, Lutomski J, Conroy R, Brugha R (2008) SLÁN 2007: survey of lifestyle, attitudes & nutrition in Ireland. Main report. Department of Health and Children, Dublin

    Google Scholar 

  31. Heys L, Fjeldstad I, Krogstad K, Kaasa S, Falkmer UG (2002) Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med 16:33–42

    Article  Google Scholar 

  32. Bauer J, Capra S, Ferguson M (2002) Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785

    Article  CAS  PubMed  Google Scholar 

  33. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497

    Article  CAS  PubMed  Google Scholar 

  34. Heys SD, Walker LG, Deehan DJ, Eremin OE (1998) Serum albumin: a prognostic indicator in patients with colorectal cancer. J R Coll Surg Edinb 43:163–168

    CAS  PubMed  Google Scholar 

  35. Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, Hoffman S, Lis CG (2004) Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 80:1634–1638

    CAS  PubMed  Google Scholar 

  36. Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF (2005) Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59:35–40

    Article  CAS  PubMed  Google Scholar 

  37. Dixon MR, Haukoos JS, Udani SM, Naghi JJ, Arnell TD, Kumar RR (2003) Carcinoembryonic antigen and albumin predict survival in patients with advanced colon and rectal cancer. Arch Surg 138:962–966

    Article  PubMed  Google Scholar 

  38. Steinberg J, Erlichman C, Gadalla T, Fine S, Wong A (1992) Prognostic factors in patients with metastatic colorectal cancer receiving 5-fluorouracil and folinic acid. Eur J Cancer 28A:1817–1820

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Ms. Charlotte Stuart, Colorectal Cancer Database Manager.

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Authors and Affiliations

  1. Department of Surgery, St James’s Hospital and Trinity College Dublin, Dublin, Ireland

    Brain Mehigan, Richard Stephens & John V. Reynolds

  2. Department of Clinical Nutrition, St James’s Hospital and Trinity College Dublin, Dublin, Ireland

    Laura A. Healy & Aoife M. Ryan

  3. Student Dietitian, Trinity College Dublin, Dublin, Ireland

    Ellis Sutton

  4. Dublin Institute of Technology (DIT), Dublin, Ireland

    Katherine Younger

  5. Department of Clinical Surgery, St James’s Hospital and Trinity College, Dublin 8, Ireland

    John V. Reynolds

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  1. Laura A. Healy
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  2. Aoife M. Ryan
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  4. Katherine Younger
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  5. Brain Mehigan
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  6. Richard Stephens
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  7. John V. Reynolds
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Correspondence to John V. Reynolds.

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Healy, L.A., Ryan, A.M., Sutton, E. et al. Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis 25, 1293–1299 (2010). https://doi.org/10.1007/s00384-010-0963-0

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