Advertisement

Surgery Today

, Volume 49, Issue 5, pp 401–409 | Cite as

The effect of increased body mass index values on surgical outcomes after radical resection for low rectal cancer

  • Xubing Zhang
  • Qingbin Wu
  • Chaoyang Gu
  • Tao Hu
  • Liang Bi
  • Ziqiang WangEmail author
Original Article
  • 40 Downloads

Abstract

Purposes

This study aimed to explore the effect of increased body mass index (BMI) values (overweight: BMI ≥ 25–30 kg/m2; obese: BMI ≥ 30 kg/m2) on surgical outcomes after radical resection for low rectal cancer (LRC).

Methods

Patients with LRC who underwent radical surgery from January 2009 to December 2013 were included. The patients were divided into three groups according to their BMI values (control group: BMI < 25 kg/m2; overweight group: BMI 25 to < 30 kg/m2; obese group: BMI ≥ 30 kg/m2). The patients’ clinicopathological characteristics and survival data were collected and analyzed.

Results

A total of 792 patients were enrolled in this study finally (control, n = 624; overweight, n = 147; obese, n = 21). The baseline characteristics of the three groups were similar. We found that an increased BMI was associated with a longer operative time (P < 0.001) and length of postoperative hospital stay (P = 0.032). Patients with increased BMI values had a significantly higher incidence of postoperative complications, including pulmonary infection (P = 0.008), anastomotic leakage (P = 0.029), allergy (P = 0.017) and incisional hernia (P = 0.045). The limited data showed that the pathological outcomes of the three groups did not differ to a statistically significant extent. A multivariate analysis showed that increased BMI was not associated with poorer OS or DFS.

Conclusion

In LRC resection, an increased BMI was associated with a longer operative time, postoperative hospital stay, and an increased number of postoperative complications. However, it did not contribute to poorer pathological or survival outcomes.

Keywords

Body mass index Low rectal cancer Surgical outcome Complication Survival 

Notes

Acknowledgements

This work was supported by the Science and Technology Support Program of the Science and Technology Department of Sichuan Province (Grant numbers: 2016SZ0043).

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

References

  1. 1.
    Nicholls J. Rectal cancer seen over 30 years. Colorectal Disease. 2014;16(9):659.CrossRefGoogle Scholar
  2. 2.
    Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C. Low rectal cancer: classification and standardization of surgery. Dis Colon Rectum. 2013;56(5):560–7.CrossRefGoogle Scholar
  3. 3.
    Dietz DW. Multidisciplinary management of rectal cancer: the OSTRICH. J Gastrointest Surg. 2013;17(10):1863–8.CrossRefGoogle Scholar
  4. 4.
    Allaix ME, Fichera A. Modern rectal cancer multidisciplinary treatment: the role of radiation and surgery. Ann Surg Oncol. 2013;20(9):2921–8.CrossRefGoogle Scholar
  5. 5.
    de Chaisemartin C, Penna C, Goere D, Benoist S, Beauchet A, Julie C, et al. Presentation and prognosis of local recurrence after total mesorectal excision. Colorectal Dis. 2009;11(1):60–6.CrossRefGoogle Scholar
  6. 6.
    Bebenek M, Pudelko M, Cisarz K, Balcerzak A, Tupikowski W, Wojciechowski L, et al. Therapeutic results in low-rectal cancer patients treated with abdominosacral resection are similar to those obtained by means of anterior resection in mid- and upper-rectal cancer cases. Eur J Surg Oncol. 2007;33(3):320–3.CrossRefGoogle Scholar
  7. 7.
    Jeong SY, Park JW, Nam BH, Kim S, Kang SB, Lim SB, et al. 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. 2014;15(7):767–74.CrossRefGoogle Scholar
  8. 8.
    Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM. Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. J Gastrointest Surg. 2014;18(7):1358–72.CrossRefGoogle Scholar
  9. 9.
    Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E. Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis. 2013;15(4):463–9.CrossRefGoogle Scholar
  10. 10.
    Shukla PJ, Makino T, Trencheva K, Milsom JW. Challenges of improving outcomes of rectal cancer surgery in obese patients. J Am Coll Surg. 2011;212(1):130 (author reply-1).CrossRefGoogle Scholar
  11. 11.
    Wang K, Wang D, Pan L, Yu Y, Dong F, Li L, et al. Prevalence of obesity and related factors among Bouyei and Han peoples in Guizhou Province, Southwest China. PLoS One. 2015;10(6):e0129230.CrossRefGoogle Scholar
  12. 12.
    Levi Z, Kark JD, Katz LH, Twig G, Derazne E, Tzur D, et al. Adolescent body mass index and risk of colon and rectal cancer in a cohort of 1.79 million Israeli men and women: a population-based study. Cancer. 2017;123(20):4022–30.CrossRefGoogle Scholar
  13. 13.
    Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346–55.CrossRefGoogle Scholar
  14. 14.
    Sun Y, Chi P. Impact of body mass index on surgical and oncological outcomes in laparoscopic total mesorectal excision for locally advanced rectal cancer after neoadjuvant 5-fluorouracil-based chemoradiotherapy. Gastroenterol Res Pract. 2017;2017:1509140.Google Scholar
  15. 15.
    Doleman B, Mills KT, Lim S, Zelhart MD, Gagliardi G. Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis. Tech Coloproctol. 2016;20(8):517–35.CrossRefGoogle Scholar
  16. 16.
    Kwak HD, Ju JK, Kang DW, Baek SJ, Kwak JM, Kim J, et al. Outcomes according to body mass index following laparoscopic surgery in patients with colorectal cancer. Gastroenterol Res Pract. 2018;14(2):134–9.Google Scholar
  17. 17.
    Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T, et al. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc. 2011;25(6):1907–12.CrossRefGoogle Scholar
  18. 18.
    Keller DS, Park KJ, Augestad KM, Delaney CP. Integration of open and laparoscopic approaches for rectal cancer resection: oncologic and short-term outcomes. Surg Endosc. 2014;28(7):2129–36.CrossRefGoogle Scholar
  19. 19.
    Wu QB, Deng XB, Zhang XB, Kong LH, Zhou ZG, Wang ZQ. Short-term and long-term outcomes of laparoscopic versus open surgery for low rectal cancer. J Laparoendosc Adv Surg Tech Part A. 2018;28(6):637–44.CrossRefGoogle Scholar
  20. 20.
    Cakir H, Heus C, Verduin WM, Lak A, Doodeman HJ, Bemelman WA, et al. Visceral obesity, body mass index and risk of complications after colon cancer resection: a retrospective cohort study. Surgery. 2015;157(5):909–15.CrossRefGoogle Scholar
  21. 21.
    Kawamata F, Homma S, Minagawa N, Kawamura H, Takahashi N, Taketomi A. Comparison of single-incision plus one additional port laparoscopy-assisted anterior resection with conventional laparoscopy-assisted anterior resection for rectal cancer. World J Surg. 2014;38(10):2716–23.CrossRefGoogle Scholar
  22. 22.
    Jeong SH, Kim P, Yi SW, Kim YJ, Baeg MK, Yi JJ. Body mass index and gastrointestinal cancer mortality in Korean adults: a prospective cohort study. J Gastroenterol Hepatol. 2018;33(9):1582–9.CrossRefGoogle Scholar
  23. 23.
    Bell S, Kong JC, Wale R, Staples M, Oliva K, Wilkins S, et al. The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Dis. 2018;20(9):778–88.CrossRefGoogle Scholar
  24. 24.
    Kuritzkes BA, Pappou EP, Kiran RP, Baser O, Fan L, Guo X, et al. Visceral fat area, not body mass index, predicts postoperative 30-day morbidity in patients undergoing colon resection for cancer. Int J Colorectal Dis. 2018;33(8):1019–28.CrossRefGoogle Scholar
  25. 25.
    Hovaguimian F, Lysakowski C, Elia N, Tramer MR. Effect of intraoperative high inspired oxygen fraction on surgical site infection, postoperative nausea and vomiting, and pulmonary function: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2013;119(2):303–16.CrossRefGoogle Scholar
  26. 26.
    Nakayama M, Yoshimatsu K, Yokomizo H, Yano Y, Okayama S, Satake M, et al. Incidence and risk factors for incisional hernia after open surgery for colorectal cancer. Hepato-gastroenterology. 2014;61(133):1220–3.Google Scholar
  27. 27.
    Kroenke CH, Neugebauer R, Meyerhardt J, Prado CM, Weltzien E, Kwan ML, et al. Analysis of body mass index and mortality in patients with colorectal cancer using causal diagrams. JAMA Oncol. 2016;2(9):1137–45.CrossRefGoogle Scholar
  28. 28.
    Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531–41.CrossRefGoogle Scholar
  29. 29.
    Sun Y, Xu Z, Lin H, Lu X, Huang Y, Huang S, et al. Impact of body mass index on treatment outcome of neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Eur J Surg Oncol. 2017;43(10):1828–34.CrossRefGoogle Scholar
  30. 30.
    Nir S, Greenberg R, Shacham-Shmueli E, White I, Schneebaum S, Avital S. Number of retrieved lymph nodes and survival in node-negative patients undergoing laparoscopic colorectal surgery for cancer. Tech Coloproctol. 2010;14(2):147–52.CrossRefGoogle Scholar
  31. 31.
    Kuo YH, Lee KF, Chin CC, Huang WS, Yeh CH, Wang JY. Does body mass index impact the number of LNs harvested and influence long-term survival rate in patients with stage III colon cancer? Int J Colorectal Dis. 2012;27(12):1625–35.CrossRefGoogle Scholar
  32. 32.
    Akagi Y, Adachi Y, Kinugasa T, Oka Y, Mizobe T, Shirouzu K. Lymph node evaluation and survival in colorectal cancer: review of population-based, prospective studies. Anticancer Res. 2013;33(7):2839–47.Google Scholar
  33. 33.
    Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490–502.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Xubing Zhang
    • 1
    • 2
  • Qingbin Wu
    • 1
    • 2
  • Chaoyang Gu
    • 1
  • Tao Hu
    • 1
    • 2
  • Liang Bi
    • 1
    • 2
  • Ziqiang Wang
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgery, West China HospitalSichuan UniversityChengduChina
  2. 2.West China School of MedicineSichuan UniversityChengduChina

Personalised recommendations