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Laparoscopic colorectal cancer resections in the obese: a systematic review

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Abstract

Background

Laparoscopic colorectal cancer operations in obese patients pose technical challenges that may negatively impact oncologic adequacy. A meta-analysis was performed to assess the oncologic outcomes of laparoscopic colorectal cancer resections in obese compared to non-obese patients. Short- and long-term outcomes were assessed secondarily.

Methods

A systematic literature search was conducted from inception until October 01, 2014. Studies that compared outcomes of laparoscopic colorectal malignant neoplasms in obese and non-obese patients were selected for meta-analysis. Studies that defined obesity as body mass index (BMI) ≥ 30 kg/m2 were included. Oncologic, operative, and postoperative outcomes were evaluated. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95 % confidence intervals (CI) were calculated using fixed-effects models. For oncologic and survival outcomes, a subgroup analysis was conducted for rectal cancer and a secondary analysis was conducted for Asian studies that used a BMI cutoff of 25 kg/m2.

Results

Thirteen observational studies with a total of 4550 patients were included in the meta-analysis. Lymph node retrieval, distal, and circumferential margins, and 5-year disease-free and overall survival were similar in the obese and non-obese groups. Conversion rate (OR 2.11, 95 % CI 1.58–2.81), postoperative morbidity (OR 1.54, 95 % CI 1.21–1.97), wound infection (OR 2.43, 95 % CI 1.46–4.03), and anastomotic leak (OR 1.65, 95 % CI 1.01–2.71) were all significantly increased in the obese group.

Conclusions

Laparoscopic colorectal cancer operations in obese patients pose an increased technical challenge as demonstrated by higher conversion rates and higher risk of postoperative complications compared to non-obese patients. Despite these challenges, oncologic adequacy of laparoscopic colorectal cancer resections is comparable in both groups.

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Acknowledgments

With their permission, we have used words from a Cochrane Schizophrenia Group template for the Methods and Data Collection and Analysis sections of this study and adapted them to our needs [56]. The authors also thank Ms. Marie Demian for her editorial assistance and Ms. Robin Featherstone for her review of our protocol.

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Authors and Affiliations

  1. Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada

    Alastair Fung, Nora Trabulsi, Richard Garfinkle, Abdulaziz Saleem, Carol-Ann Vasilevsky & Marylise Boutros

  2. Department of Surgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia

    Nora Trabulsi & Abdulaziz Saleem

  3. Schulich Library of Science and Engineering, McGill University, Montreal, Canada

    Martin Morris

  4. Department of Colorectal Surgery, Cleveland Clinic, Weston, FL, USA

    Steven D. Wexner

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  1. Alastair Fung
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  2. Nora Trabulsi
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  3. Martin Morris
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  4. Richard Garfinkle
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  5. Abdulaziz Saleem
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  6. Steven D. Wexner
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Corresponding author

Correspondence to Marylise Boutros.

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Disclosures

Dr. Wexner reports personal fees from Karl Storz Endoscopy America, during the conduct of the study. Drs. Fung, Trabulsi, Morris, Garfinkle, Saleem, Vasilevsky, and Boutros have nothing to disclose.

Additional information

Poster presentation at the Canadian Association of General Surgeons 2014.

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Fung, A., Trabulsi, N., Morris, M. et al. Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc 31, 2072–2088 (2017). https://doi.org/10.1007/s00464-016-5209-y

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