The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians
The influence of obesity on surgical outcomes after laparoscopic colorectal surgery in Asian patients is unclear. The aim of this study was to evaluate the feasibility and safety of laparoscopic surgery in obese Asian patients with colorectal cancer.
We retrospectively reviewed the prospectively collected data on 984 consecutive patients who underwent laparoscopic surgery for colorectal cancer between May 2001 and February 2008. Patients were classified according to the categories proposed by the International Obesity Task Force, as Nonobese (body mass index [BMI] < 25.0 kg/m2), Obese I (BMI 25.0–29.9 kg/m2), and Obese II (BMI ≥ 30 kg/m2). Surgical outcomes, including open conversion, operation time, postoperative complications, estimated blood loss, and postoperative hospital stay, were compared in Nonobese, Obese I, and Obese II patients.
Of the 984 patients, 645 (65.5%), 312 (31.7%), and 27 (2.7%), were classified as Nonobese, Obese I, and Obese II, respectively. Clinicopathologic characteristics were similar among the three groups. The Obese II group had higher conversion rates (14.8% versus 2.6% and 2.9%, P = 0.001), longer operation time (258 versus 201 and 215 min, P = 0.001), and longer postoperative hospital stay (12.1 versus 9.5 and 9.2 days, P = 0.035) than the Nonobese and Obese I groups. However, the rates of intraoperative events (P = 0.634) and postoperative complications (P = 0.603) were similar in nonobese and obese patients. Independent risk factors for conversion were BMI group and operation type. Obese II patients had an 8.36-fold greater risk of conversion than had Nonobese patients (P = 0.001).
With sufficient experience, laparoscopic colorectal surgery in obese Asian patients is feasible and safe, offering all the benefits of a minimally invasive approach. Management of Asian colorectal cancer patients with BMI ≥ 30 kg/m2 requires meticulous perioperative care, and colorectal surgeons must be familiar with obesity-related challenges in such patients.
KeywordsColorectal cancer Laparoscopic surgery Body mass index Asian Obesity
Drs. Ji Won Park, Sang-Woo Lim, Hyo Seong Choi, Seung-Yong Jeong, Jae Hwan Oh, and Seok-Byung Lim have no conflicts of interest or financial ties to disclose.
- 11.World Health Organization, International Association for the Study of Obesity, International Obesity Task Force (2000) The Asia–Pacific perspective redefining obesity and its treatment. Health Communications, SydneyGoogle Scholar
- 14.Korea Central Cancer Registry, Ministry for Health, Welfare and Family Affairs (2008) Cancer incidence in Korea. Available at: http://www.cancer.go.kr/cms/statics/incidence/index.html. (Korean) November 2008; Accessed 18 May 2009
- 17.Thorpe H, Jayne DG, Guillou PJ, Quirke P, Copeland J, Brown JM, Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial Group (2008) Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg 95:199–205CrossRefPubMedGoogle Scholar
- 19.Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M, Yamamoto H, Monden M (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 21:929–934CrossRefPubMedGoogle Scholar
- 21.World Health Organization. Obesity. Preventing and Managing the Global Epidemic (1998) Report of a WHO Consultation on Obesity. World Health Organization, GenevaGoogle Scholar
- 28.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC Trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMedGoogle Scholar
- 29.Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMedGoogle Scholar