Does obesity impact postoperative outcomes following robotic-assisted surgery for rectal cancer?
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.
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.
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).
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.
KeywordsRectal resection Rectal cancer Robotic-assisted surgery Obesity Postoperative morbidity Postoperative ileus
We thank the members of the ‘Fondation SanTDige’ for their support by a grant to Emilie Duchalais.
The ‘Fondation SanTDige’ provided a grant to Emilie Duchalais.
Compliance with ethical standards
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.
- 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
- 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.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.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
- 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
- 15.Pigazzi A (2016) Robotic-assisted vs. Standard Laparoscopic Resection for Rectal Cancer (ROLARR study). ASCRS Annual MeetingGoogle Scholar
- 18.NCCN.org, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)—Rectal cancer. Version 2.2016Google Scholar
- 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.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