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Does obesity impact postoperative outcomes following robotic-assisted surgery for rectal cancer?

  • E. Duchalais
  • N. Machairas
  • S. R. Kelley
  • R. G. Landmann
  • A. Merchea
  • D. T. Colibaseanu
  • K. L. Mathis
  • E. J. Dozois
  • D. W. Larson
Article

Abstract

Introduction

Obesity has been identified as a risk factor for both conversion and severe postoperative morbidity in patients undergoing laparoscopic rectal resection. Robotic-assisted surgery (RAS) is proposed to overcome some of the technical limitations associated with laparoscopic surgery for rectal cancer. The aim of our study was to determine if obesity remains a risk factor for severe morbidity in patients undergoing robotic-assisted rectal resection.

Patients

This study was a retrospective review of a prospective database. A total of 183 patients undergoing restorative RAS for rectal cancer between 2007 and 2016 were divided into 2 groups: control (BMI < 30 kg/m2; n = 125) and obese (BMI ≥ 30 kg/m2; n = 58). Clinicopathologic data, 30-day postoperative morbidity, and perioperative outcomes were compared between groups. The main outcome was severe postoperative morbidity defined as any complication graded Clavien-Dindo ≥ 3.

Results

Control and obese groups had similar clinicopathologic characteristics. Severe complications were observed in 9 (7%) and 4 (7%) patients, respectively (p > 0.99). Obesity did not impact conversion, anastomotic leak rate, length of stay, or readmission but was significantly associated with increased postoperative morbidity (29 vs. 45%; p = 0.04) and especially more postoperative ileus (11 vs. 26%; p = 0.01). Obesity and male gender were the two independent risk factors for postoperative overall morbidity (OR 1.97; 95% CI 1.02–3.94; p = 0.04 and OR 2.23; 95% CI 1.10–4.76; p = 0.03, respectively).

Conclusion

‎Obesity did not impact severe morbidity or conversion rate following RAS for rectal cancer but remained a risk factor for overall morbidity and especially postoperative ileus.

Keywords

Rectal resection Rectal cancer Robotic-assisted surgery Obesity Postoperative morbidity Postoperative ileus 

Notes

Acknowledgements

We thank the members of the ‘Fondation SanTDige’ for their support by a grant to Emilie Duchalais.

Funding

The ‘Fondation SanTDige’ provided a grant to Emilie Duchalais.

Compliance with ethical standards

Disclosures

Drs Emilie Duchalais, Nikolaos Machairas, Scott R. Kelley, Ron G. Landman, Amit Merchea, Dorin T. Colibaseanu, Kellie L. Mathis, Eric J. Dozois, and David W. Larson have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    van de Velde CJH, Boelens PG, Tanis PJ, Espin E, Mroczkowski P, Naredi P, Pahlman L, Ortiz H, Rutten HJ, Breugom AJ, Smith JJ, Wibe A, Wiggers T, Valentini V (2014) Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012. Eur J Surg Oncol 40:454–468CrossRefPubMedGoogle Scholar
  2. 2.
    Bonjer HJ, Deijen CL, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 373:194–194PubMedGoogle Scholar
  3. 3.
    Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989CrossRefPubMedGoogle Scholar
  4. 4.
    Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman 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
  5. 5.
    van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218CrossRefPubMedGoogle Scholar
  6. 6.
    Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, Choi HS, Kim D-W, Chang HJ, Kim DY, Jung KH, Kim T-Y, Kang GH, Chie EK, Kim SY, Sohn DK, Kim D-H, Kim J-S, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774CrossRefPubMedGoogle Scholar
  7. 7.
    Zhou Y, Wu L, Li X, Wu X, Li B (2012) Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc 26:783–789CrossRefPubMedGoogle Scholar
  8. 8.
    Fung A, Trabulsi N, Morris M, Garfinkle R, Saleem A, Wexner SD, Vasilevsky C-A, Boutros M (2016) Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc 31:2072–2088CrossRefPubMedGoogle Scholar
  9. 9.
    Qu H, Liu Y, Bi D (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617CrossRefPubMedGoogle Scholar
  10. 10.
    Moghadamyeghaneh Z, Phelan M, Smith BR, Stamos MJ (2015) Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer. Dis Colon Rectum 58:1123–1129CrossRefPubMedGoogle Scholar
  11. 11.
    Colombo P-E, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrère S, Quénet F, Jarlier M, Rouanet P (2016) Robotic versus laparoscopic total mesorectal excision (TME) for Sphincter-saving surgery: is there any difference in the transanal TME rectal approach? Ann Surg Oncol 23:1594–1600CrossRefPubMedGoogle Scholar
  12. 12.
    Law WL, Foo DCC (2016) Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc 31:2798–2807CrossRefPubMedGoogle Scholar
  13. 13.
    Lim DR, Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2016) Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc 31:1728–1737CrossRefPubMedGoogle Scholar
  14. 14.
    Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19:516–526CrossRefPubMedGoogle Scholar
  15. 15.
    Pigazzi A (2016) Robotic-assisted vs. Standard Laparoscopic Resection for Rectal Cancer (ROLARR study). ASCRS Annual MeetingGoogle Scholar
  16. 16.
    Memon S, Heriot AG, Murphy DG, Bressel M, Lynch AC (2012) Robotic versus laparoscopic proctectomy for rectal cancer: a meta-analysis. Ann Surg Oncol 19:2095–2101CrossRefPubMedGoogle Scholar
  17. 17.
    Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19:3727–3736CrossRefPubMedGoogle Scholar
  18. 18.
    NCCN.org, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)—Rectal cancer. Version 2.2016Google Scholar
  19. 19.
    Khreiss W, Huebner M, Cima RR, Dozois ER, Chua HK, Pemberton JH, Harmsen WS, Larson DW (2014) Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer. Dis Colon Rectum 57:557–563CrossRefPubMedGoogle Scholar
  20. 20.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications. Ann Surg 250:187–196CrossRefPubMedGoogle Scholar
  21. 21.
    Lagares-Garcia J, O’Connell A, Firilas A, Robinson CC, Dumas BP, Hagen ME (2016) The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery. Int J Med Robot Comput Assist Surg 12:680–685CrossRefGoogle Scholar
  22. 22.
    Harr JN, Luka S, Kankaria A, Juo Y-Y, Agarwal S, Obias V (2016) Robotic-assisted colorectal surgery in obese patients: a case-matched series. Surg Endosc 31:2813–2819CrossRefPubMedGoogle Scholar
  23. 23.
    Keller DS, Madhoun N, Flores-Gonzalez JR, Ibarra S, Tahilramani R, Haas EM (2016) Effect of BMI on short-term outcomes with robotic-assisted laparoscopic surgery: a case-matched study. J Gastrointest Surg 20:488–493CrossRefPubMedGoogle Scholar
  24. 24.
    Baukloh JK, Reeh M, Spinoglio G, Corratti A, Bartolini I, Mirasolo VM, Priora F, Izbicki JR, Gomez Fleitas M, Gomez Ruiz M, Perez DR (2017) Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol 43:1304–1311CrossRefPubMedGoogle Scholar
  25. 25.
    Heus C, Cakir H, Lak A, Doodeman HJ, Houdijk APJ (2016) Visceral obesity, muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation. Int J Surg 29:159–164CrossRefPubMedGoogle Scholar
  26. 26.
    Bokey L, Chapuis PH, Dent OF (2014) Impact of obesity on complications after resection for rectal cancer. Color Dis 16:896–906CrossRefGoogle Scholar
  27. 27.
    Bhattarai Y, Fried D, Gulbransen B, Kadrofske M, Fernandes R, Xu H, Galligan J (2016) High-fat diet-induced obesity alters nitric oxide-mediated neuromuscular transmission and smooth muscle excitability in the mouse distal colon. Am J Physiol 311:G210–G220Google Scholar
  28. 28.
    Stenkamp-Strahm CM, Nyavor YEA, Kappmeyer AJ, Horton S, Gericke M, Balemba OB (2015) Prolonged high fat diet ingestion, obesity, and type 2 diabetes symptoms correlate with phenotypic plasticity in myenteric neurons and nerve damage in the mouse duodenum. Cell Tissue Res 361:411–426CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E (2013) Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Color Dis 15:463–469CrossRefGoogle Scholar
  30. 30.
    Gorgun E, Ozben V, Costedio M, Stocchi L, Kalady M, Remzi F (2016) Robotic versus conventional laparoscopic rectal cancer surgery in obese patients. Color Dis 18:1063–1071CrossRefGoogle Scholar
  31. 31.
    Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamakawa Y (2016) Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701–1710CrossRefPubMedGoogle Scholar
  32. 32.
    Chen B, Zhang Y, Zhao S, Yang T, Wu Q, Jin C, He Y, Wang Z (2016) The impact of general/visceral obesity on completion of mesorectum and perioperative outcomes of laparoscopic TME for rectal cancer. Medicine (Baltimore) 95:e4462CrossRefGoogle Scholar
  33. 33.
    Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, Ishibe A, Watanabe K, Akiyama H, Ichikawa Y, Morita S, Endo I (2014) The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis 29:343–351CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Colon & Rectal SurgeryMayo ClinicJacksonvilleUSA

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