Skip to main content

Advertisement

SpringerLink
Log in

Visceral obesity determined by CT scan and outcomes after colorectal surgery; a systematic review and meta-analysis

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Visceral obesity may affect outcome after colorectal surgery. The visceral fat area as determined by CT scanning is considered the standard in the detection of visceral obesity.

Method

A systematic review was performed of trials investigating the effect of visceral obesity on outcomes of patients with colorectal cancer with no radiotherapy or chemotherapy and measured by CT scanning. The main endpoints were primary hospital stay, morbidity, operative time and blood loss. Quality assessment and data extraction were performed independently by two observers.

Results

Seven studies were eligible for analysis, including 1230 patients. Primary hospital stay (weighted mean difference 1.16 days, 95 % CI 0.0.05 to 2.28 days, p = 0.04), morbidity rates (RR 0.15, 95 % CI 0.10 to 0.21, p < 0.00001) and operative time (weighted mean difference 20.47 min, 95 % CI 12.76 to 28.17 min, p < 0.00001) were significantly higher for visceral obese patients. No difference was found in blood loss.

Conclusion

Visceral obesity leads to a longer hospital stay, higher morbidity and longer operative time after elective colon surgery. These findings show that the preoperative CT scan for detecting disseminated disease can be used to assess visceral obesity and helps in risk profiling patients undergoing elective colon surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Weitz J, Koch M, Debus J, Höhler T, Galle PR, Büchler MW (2005) Colorectal cancer. Lancet 365(9454):153–165

    Article  PubMed  Google Scholar 

  2. Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Color Dis 8(5):375–388

    Article  CAS  Google Scholar 

  3. Yamamoto N1, Fujii S, Sato T, Oshima T, Rino Y, Kunisaki C, Masuda M, Imada T (2012) Impact of body mass index and visceral adiposity on outcomes in colorectal cancer. Asia Pac J Clin Oncol 8(4):337–45

  4. Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O, Lefor AT (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51(12):1757–1765. doi:10.1007/s10350-008-9395-0, discussion 1765–7

    Article  PubMed  Google Scholar 

  5. Mørkedal B, Romundstad PR, Vatten LJ (2011) Informativeness of indices of blood pressure, obesity and serum lipids in relation to ischaemic heart disease mortality: the HUNT-II study. Eur J Epidemiol 26(6):457–461. doi:10.1007/s10654-011-9572-7

    Article  PubMed Central  PubMed  Google Scholar 

  6. Picon PX, Leitão CB, Gerchman F, Azevedo MJ, Silveiro SP, Gross JL, Canani LH (2007) Waist measure and waist to hip ratio and identification of cardiovascular risk: multicentric study in type 2 diabetes mellitus patients. Arq Bras Endocrinol Metabol 51(3):443–449

    Article  PubMed  Google Scholar 

  7. Cecchini S, Cavazzini E, Marchesi F, Sarli L, Roncoroni L (2011) Computed tomography volumetric fat parameters versus body mass index for predicting short-term outcomes of colon surgery. World J Surg 35(2):415–423. doi:10.1007/s00268-010-0888-3

    Article  PubMed  Google Scholar 

  8. Shuster A, Patlas M, Pinthus JH, Mourtzakis M (2012) The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol 85(1009):1–10. doi:10.1259/bjr/38447238

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012

    Article  PubMed  Google Scholar 

  10. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

  11. Kang J, Baek SE, Kim T, Hur H, Min BS, Lim JS, Kim NK, Lee KY (2012) Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Color Dis 27(4):497–505. doi:10.1007/s00384-011-1333-2

  12. Rickles AS, Iannuzzi JC, Mironov O, Deeb AP, Sharma A, Fleming FJ, Monson JR (2013) Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg 17(1):133–143. doi:10.1007/s11605-012-2045-9, discussion p.143

    Article  PubMed  Google Scholar 

  13. 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(3):343–351. doi:10.1007/s00384-013-1803-9

  14. Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M (2005) Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 92(10):1261–1262

    Article  CAS  PubMed  Google Scholar 

  15. Sakai T, Maekawa T, Mikami K, Kuramochi H, Noda S (2009) Visceral fat volume and surgical outcomes of colorectal resection. Int Surg 94(4):370–372

    PubMed  Google Scholar 

  16. Després JP (2006) Is visceral obesity the cause of the metabolic syndrome? Ann Med 38(1):52–63

    Article  PubMed  Google Scholar 

  17. Després JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444(7121):881–887, Review

    Article  PubMed  Google Scholar 

  18. Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50(12):2223–2237

    Article  PubMed  Google Scholar 

  19. Nitori N, Hasegawa H, Ishii Y, Endo T, Kitagawa Y (2009) Impact of visceral obesity on short-term outcome after laparoscopic surgery for colorectal cancer: a single Japanese center study. Surg Laparosc Endosc Percutan Tech 19(4):324–327. doi:10.1097/SLE.0b013e3181ae5442

    Article  PubMed  Google Scholar 

  20. Moon HG, Ju YT, Jeong CY, Jung EJ, Lee YJ, Hong SC, Ha WS, Park ST, Choi SK (2008) Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol 15(7):1918–1922. doi:10.1245/s10434-008-9891-4

    Article  PubMed  Google Scholar 

  21. Ballian N, Lubner MG, Munoz A, Harms BA, Heise CP, Foley EF, Kennedy GD (2012) Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol 105(4):365–370. doi:10.1002/jso.22031

    Article  PubMed  Google Scholar 

  22. 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(6):929–934

    Article  CAS  PubMed  Google Scholar 

  23. Ueda J, Ichimiya H, Okido M, Kato M (2009) The impact of visceral fat accumulation on laparoscopy-assisted distal gastrectomy for early gastric cancer. J Laparoendosc Adv Surg Tech A 19(2):157–162. doi:10.1089/lap.2008.0113

    Article  PubMed  Google Scholar 

  24. Yoshikawa K, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Miyatani T, Komatsu M, Mikami C, Kashihara H (2011) Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer. Surg Endosc 25(12):3825–3830. doi:10.1007/s00464-011-1798-7

    Article  PubMed  Google Scholar 

  25. Miyaki A, Imamura K, Kobayashi R, Takami M, Matsumoto J (2013) Impact of visceral fat on laparoscopy-assisted distal gastrectomy. Surgeon 11(2):76–81. doi:10.1016/j.surge.2012.07.001

  26. Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T (2009) Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg 96(5):496–500. doi:10.1002/bjs.6586

    Article  CAS  PubMed  Google Scholar 

  27. Shimizu A, Tani M, Kawai M, Hirono S, Miyazawa M, Uchiyama K, Yamaue H (2011) Influence of visceral obesity for postoperative pulmonary complications after pancreaticoduodenectomy. J Gastrointest Surg 15(8):1401–1410. doi:10.1007/s11605-011-1436-7

    Article  PubMed  Google Scholar 

  28. Hagiwara M, Miyajima A, Hasegawa M, Jinzaki M, Kikuchi E, Nakagawa K, Oya M (2012) Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy. BJU Int 110(11):E980–E984. doi:10.1111/j.1464-410X.2012.11274.x

    Article  PubMed  Google Scholar 

  29. Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd, Cummings B, Gunderson L, Macdonald JS, Mayer RJ (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19(1):157–163

    CAS  PubMed  Google Scholar 

  30. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99(6):433–441, Review

    Article  PubMed  Google Scholar 

  31. Mekenkamp LJ, van Krieken JH, Marijnen CA, van de Velde CJ, Nagtegaal ID, Pathology Review Committee and the Co-operative Clinical Investigators (2009) Lymph node retrieval in rectal cancer is dependent on many factors—the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol 33(10):1547–1553. doi:10.1097/PAS.0b013e3181b2e01f

    Article  PubMed  Google Scholar 

  32. Bouchard C, Després JP, Mauriège P (1993) Genetic and nongenetic determinants of regional fat distribution. Endocr Rev 14(1):72–93, Review

    Article  CAS  PubMed  Google Scholar 

  33. Kvist H, Chowdhury B, Sjöström L, Tylén U, Cederblad A (1988) Adipose tissue volume determination in males by computed tomography and 40 K. Int J Obes 12(3):249–266

    CAS  PubMed  Google Scholar 

  34. Goodpaster BH, Kelley DE, Wing RR, Meier A, Thaete FL (1999) Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 48(4):839–847

    Article  CAS  PubMed  Google Scholar 

  35. Park HS, Lee K (2005) Greater beneficial effects of visceral fat reduction compared with subcutaneous fat reduction on parameters of the metabolic syndrome: a study of weight reduction programmes in subjects with visceral and subcutaneous obesity. Diabet Med 22(3):266–272

    Article  CAS  PubMed  Google Scholar 

  36. Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity (2002) New criteria for ‘obesity disease’ in Japan. Circ J 66(11):987–992

    Article  Google Scholar 

  37. Yoshizumi T, Nakamura T, Yamane M, Islam AH, Menju M, Yamasaki K, Arai T, Kotani K, Funahashi T, Yamashita S, Matsuzawa Y (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211(1):283–286

    Article  CAS  PubMed  Google Scholar 

  38. Rössner S, Bo WJ, Hiltbrandt E, Hinson W, Karstaedt N, Santago P, Sobol WT, Crouse JR (1990) Adipose tissue determinations in cadavers—a comparison between cross-sectional planimetry and computed tomography. Int J Obes 14(10):893–902

    PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank F.S. van Etten-Jamaludin of the Medical Library for helping us with performing the search.

Author contributions

Cakir H and Heus C collected data, performed the analyses and drafted the manuscript. Van der Ploeg JT analysed the data and critically revised the manuscript. Houdijk AP contributed to the design and critically revised the manuscript. All authors approved the final version.

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, Medical Centre Alkmaar, PO 1815 JD, Alkmaar, The Netherlands

      Hamit Cakir, Colin Heus, Tjeerd J. van der Ploeg & Alexander P. J. Houdijk

    2. Trial Center Holland Health, Kennemerstraatweg 10, 1815 LA, Alkmaar, The Netherlands

      Alexander P. J. Houdijk

    Authors
    1. Hamit Cakir
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Colin Heus
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Tjeerd J. van der Ploeg
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Alexander P. J. Houdijk
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Alexander P. J. Houdijk.

    Additional information

    Hamit Cakir and Colin Heus contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Cakir, H., Heus, C., van der Ploeg, T.J. et al. Visceral obesity determined by CT scan and outcomes after colorectal surgery; a systematic review and meta-analysis. Int J Colorectal Dis 30, 875–882 (2015). https://doi.org/10.1007/s00384-015-2174-1

    Download citation

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00384-015-2174-1

    Keywords

    Search

    Navigation