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Computed Tomography Volumetric Fat Parameters versus Body Mass Index for Predicting Short-term Outcomes of Colon Surgery

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Abstract

Background

At present, the impact of obesity on short-term outcomes of general surgery remains controversial, especially in the field of laparoscopy. Most studies on the subject have used the body mass index (BMI) to define obesity without distinguishing between visceral and subcutaneous storage. Computed tomography (CT) volumetric analysis permits accurate evaluation of site-specific volume of adipose tissue. The purpose of this study was to compare CT volumetric fat parameters and the BMI for predicting short-term outcomes of colon surgery.

Methods

A retrospective analysis was conducted of 231 consecutive patients undergoing elective colon resection, with open or laparoscopic technique, from January 2007 to April 2009. CT volumetric quantification of abdominal visceral and subcutaneous adipose tissue was performed. Intraoperative and perioperative data were collected.

Results

A total of 187 patients were enrolled. BMI showed a direct correlation with fat volumetric parameters but not with the visceral/subcutaneous fat ratio. Operating time was correlated with subcutaneous fat storage and BMI in the laparoscopic right colectomy subgroup. No associations were found with the conversion rate. Length of the hospital stay was correlated with the visceral/subcutaneous fat ratio in the laparoscopic left colectomy subgroup. Whereas the overall postoperative complication rate and mortality were not associated with fat parameters, the postoperative surgical complication rate was associated with visceral volumetric parameters in the laparoscopic left colectomy subgroup.

Conclusions

Short-term outcomes of colon surgery are better predicted by fat volumetric parameters than by the BMI. This study has provided new elements for discussion on the impact of visceral and subcutaneous adiposity in laparoscopic and traditional colon surgery.

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References

  1. Dindo D, Muller MK, Weber M et al (2003) Obesity in general elective surgery. Lancet 361:2032–2035

    Article  PubMed  Google Scholar 

  2. Scheidbach H, Benedix F, Hügel O et al (2008) Laparoscopic approach to colorectal procedures in the obese patient: risk factor or benefit? Obes Surg 18:66–70

    Article  PubMed  Google Scholar 

  3. Lascano CA, Kaidar-Person O, Szomstein S et al (2006) Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg 192:357–365

    Article  PubMed  Google Scholar 

  4. Bège T, Lelong B, Francon D et al (2009) Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 23:1460–1464

    Article  PubMed  Google Scholar 

  5. Gendall KA, Raniga S, Kennedy R et al (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237

    Article  PubMed  Google Scholar 

  6. Senagore AJ, Delaney CP, Madboulay K et al (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7:558–561

    Article  PubMed  Google Scholar 

  7. Blee TH, Belzer GE, Lambert PJ (2002) Obesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma? Am Surg 68:163–166

    PubMed  Google Scholar 

  8. Efron JE, Uriburu JP, Wexner SD et al (2001) Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients. Obes Surg 11:246–251

    Article  CAS  PubMed  Google Scholar 

  9. Tuech JJ, Regenet N, Hennekinne S et al (2001) Laparoscopic colectomy for sigmoid diverticulitis in obese and nonobese patients: a prospective comparative study. Surg Endosc 15:1427–1430

    CAS  PubMed  Google Scholar 

  10. Merkow RP, Bilimoria KY, McCarter MD et al (2009) Effect of body mass index on short-term outcomes after colectomy for cancer. J Am Coll Surg 208:53–61

    Article  PubMed  Google Scholar 

  11. Pikarsky AJ, Saida Y, Yamaguchi T et al (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858

    Article  CAS  PubMed  Google Scholar 

  12. Leroy J, Ananian P, Rubino F et al (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241:69–76

    PubMed  Google Scholar 

  13. Schwandner O, Farke S, Schiedeck TH et al (2004) Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 18:1452–1456

    Article  CAS  PubMed  Google Scholar 

  14. Benoist S, Panis Y, Alves A et al (2000) Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 179:275–281

    Article  CAS  PubMed  Google Scholar 

  15. Seki Y, Ohue M, Sekimoto M et al (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 21:929–934

    Article  CAS  PubMed  Google Scholar 

  16. Tsujinaka S, Konishi F, Kawamura YJ et al (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1765 (discussion 1765–1767)

    Article  PubMed  Google Scholar 

  17. Ishii Y, Hasegawa H, Nishibori H et al (2005) Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 92:1261–1262

    Article  CAS  PubMed  Google Scholar 

  18. Bouchard C, Despres JP, Mauriege P (1993) Genetic and nongenetic determinants of regional fat distribution. Endocr Rev 14:72–74

    CAS  PubMed  Google Scholar 

  19. Wajchenberg BL (2000) Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 21:697–738

    Article  CAS  PubMed  Google Scholar 

  20. Maurovich-Horvat P, Massaro J, Fox CS et al (2007) Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. Int J Obes (Lond) 31:500–506

    Article  CAS  Google Scholar 

  21. Poirier P, Despres JP (2003) Waist circumference, visceral obesity, and cardiovascular risk. J Cardiopulm Rehabil 23:161–169

    Article  PubMed  Google Scholar 

  22. Pou KM, Massaro JM, Hoffmann U et al (2009) Patterns of abdominal fat distribution: the Framingham Heart Study. Diabetes Care 32:448–481

    Article  Google Scholar 

  23. Schwenk W, Haase O, Neudecker J, et al (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145

  24. Neudecker J, Klein F, Bittner R et al (2009) Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 96:1458–1467

    Article  CAS  PubMed  Google Scholar 

  25. Doyle SL, Lysaght J, Reynolds JV (2010) Obesity and post-operative complications in patients undergoing non-bariatric surgery. Obes Rev 11:875–886

    Article  CAS  PubMed  Google Scholar 

  26. WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  27. Seike K, Koda K, Oda K et al (2009) Gender differences in pelvic anatomy and effects on rectal cancer surgery. Hepatogastroenterology 56:111–115

    PubMed  Google Scholar 

  28. Grams J, Tong W, Greenstein AJ et al (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891

    Article  PubMed  Google Scholar 

  29. Raftopoulos I, Courcoulas AP, Blumberg D (2006) Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon? Surgery 140:675–682 (discussion 682–683)

    Article  PubMed  Google Scholar 

  30. Sarli L, Rollo A, Cecchini S et al (2009) Impact of obesity on laparoscopic-assisted left colectomy in different stages of the learning curve. Surg Laparosc Endosc Percutan Tech 19:114–117

    Article  PubMed  Google Scholar 

  31. Cohen ME, Bilimoria KY, Ko CY et al (2009) Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program. Ann Surg 250:901–907

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Kathleen Page and Giorgio Concari, MD.

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Authors and Affiliations

  1. Section of General Surgery, Department of Surgical Sciences, Parma City Hospital, Parma University—Medical School, 14 Gramsci Street, Parma, 43100, Italy

    Stefano Cecchini, Federico Marchesi, Leopoldo Sarli & Luigi Roncoroni

  2. Department of Engineering, ENEA, PROTINN, Bologna, Italy

    Egildo Cavazzini

Authors
  1. Stefano Cecchini
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  2. Egildo Cavazzini
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  3. Federico Marchesi
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  4. Leopoldo Sarli
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  5. Luigi Roncoroni
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Correspondence to Stefano Cecchini.

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Cecchini, S., Cavazzini, E., Marchesi, F. et al. Computed Tomography Volumetric Fat Parameters versus Body Mass Index for Predicting Short-term Outcomes of Colon Surgery. World J Surg 35, 415–423 (2011). https://doi.org/10.1007/s00268-010-0888-3

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  • DOI: https://doi.org/10.1007/s00268-010-0888-3

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