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Impact of obesity on morbidity and oncologic outcomes after total mesorectal excision for mid and low rectal cancer

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Abstract

Background

A recent meta-analysis showed that obesity increased the conversion rate and postoperative morbidity of rectal cancer surgery, but did not influence pathological results. However, this meta-analysis included patients with cancer of the upper rectum and had many biases. The aim of the present retrospective study was to investigate the impact of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, on postoperative morbidity and short- and long-term oncologic outcomes of total mesorectal excision for mid and low rectal cancer in consecutive patients.

Methods

This study included all eligible patients who were operated on for mid and lower rectal cancer between 1999 and 2018 in our hospital. We compared 90-day postoperative morbidity and mortality, and short- and long-term oncologic outcomes between obese and non-obese patients.

Results

Three hundred and ninety patients [280 males, mean age 65.7 ± 11.3 years, 59 obese individuals (15.1%)] were included. There was no difference in the 90-day mortality rate between obese and non-obese groups (p = 0.068). There was a difference in the overall 90-day morbidity rate between the obese and non-obese groups that disappeared after propensity score matching of the patients. There was no difference in short-term oncological parameters, with a median follow-up of 43 (20–84) months, and there were no significant differences in disease-free and overall survival between obese and non-obese patients (p = 0.42 and p = 0.11, respectively).

Conclusions

Obesity does not affect the 90-day morbidity rate, or short- and long-term oncologic results in patients operated on for mid and lower rectal cancer.

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Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France

    L. Gutierrez, A. Bonne, B. Trilling, E. Girard & J.-L. Faucheron

  2. University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France

    B. Trilling, E. Girard & J.-L. Faucheron

  3. Research Division, Grenoble Alpes University Hospital, 38000, Grenoble, France

    A. Foote

  4. Department of Pathology, Grenoble Alpes University Hospital, 38000, Grenoble, France

    M.-H. Laverrière

  5. Department of Hepato-Gastroenterology, Grenoble Alpes University Hospital, 38000, Grenoble, France

    G. Roth

  6. Department of Public Health, Grenoble Alpes University Hospital, 38000, Grenoble, France

    J. Fournier

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  1. L. Gutierrez
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  9. J.-L. Faucheron
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Corresponding author

Correspondence to J.-L. Faucheron.

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The authors declare that they have no conflict of interest.

Ethical approval and Informed consent

The requirements for anonymization of personal data by the Data Protection Act 1998 were satisfied. According to the French Health Authority (HAS), this study was classified as category 3 (as defined by the French legislation “Jardé Law”); therefore, there was no need for the patient’s consent as it was considered an audit [17]. Study ethics approval was obtained on 19 May 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).

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Fig. S1

: Propensity score-matching: absolute mean differences. (DOCX 92 KB)

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Supplementary file 3 (DOCX 42 KB)

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Gutierrez, L., Bonne, A., Trilling, B. et al. Impact of obesity on morbidity and oncologic outcomes after total mesorectal excision for mid and low rectal cancer. Tech Coloproctol 27, 407–418 (2023). https://doi.org/10.1007/s10151-022-02725-7

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  • DOI: https://doi.org/10.1007/s10151-022-02725-7

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