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Visceral fat area, not body mass index, predicts postoperative 30-day morbidity in patients undergoing colon resection for cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Colectomy for cancer in obese patients is technically challenging and may be associated with worse outcomes. Whether visceral obesity, as measured on computed tomography, is a better predictor of complication than body mass index (BMI) or determines long-term oncologic outcomes has not been well characterized. This study examines the association between derived anthropometrics and postoperative complication and long-term oncologic outcomes.

Methods

Retrospective review of patients undergoing elective colectomy for cancer at a single tertiary-care center from 2010 to 2016. Adipose tissue distribution measurements, including visceral fat area (VFA), were determined from preoperative imaging. The primary outcome was 30-day postoperative complication; secondary outcomes included overall and disease-free survival. Multivariable logistic regression was performed to determine association between obesity metrics and outcome.

Results

Two hundred and sixty-four patients underwent 266 primary resections of colon cancer. Twenty-eight patients (10.5%) developed major morbidity (Clavien-Dindo grade ≥ III). VFA but not BMI was significantly associated with morbidity in multivariate analysis (p = 0.004, odds ratio 1.99, 95% confidence interval 1.25–3.19). No other imaging-derived anthropometric was associated with increased morbidity. In receiver operating characteristic analysis, VFA was predictive of major morbidity (area under curve 0.660). A cutoff value of VFA ≥ 191 cm2 was associated with 50% sensitivity and 76% specificity for predicting major morbidity. Patients with VFA ≥ 191cm2 had 19.4% risk of morbidity, whereas those with < 191 cm2 had 7.2% risk (relative risk ratio 2.69, unadjusted p = 0.004). Neither VFA nor BMI was associated with overall or disease-free survival.

Conclusion

VFA but not BMI predicts morbidity following elective surgery for colon cancer.

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Acknowledgments

The authors would like to acknowledge Steven A. Lee-Kong, MD, and Daniel L. Feingold, MD, for their contributions to this manuscript.

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Authors and Affiliations

  1. Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY, 10032, USA

    Benjamin A. Kuritzkes & Ravi P. Kiran

  2. Division of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emmanouil P. Pappou

  3. Center for Innovation and Outcomes Research, New York Presbyterian/Columbia University Medical Center, New York, NY, USA

    Ravi P. Kiran, Onur Baser & Liqiong Fan

  4. Computational Image Analysis Laboratory, Department of Radiology, New York Presbyterian/Columbia University Medical Center, New York, NY, USA

    Xiaotao Guo & Binsheng Zhao

  5. Division of Abdominal Radiology, New York Presbyterian/Columbia University Medical Center, New York, NY, USA

    Stuart Bentley-Hibbert

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  1. Benjamin A. Kuritzkes
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  2. Emmanouil P. Pappou
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Corresponding author

Correspondence to Benjamin A. Kuritzkes.

Ethics declarations

This study was approved by the Columbia University Medical Center Institutional Review Board with waiver of informed consent.

Conflict of interest

This manuscript has been reviewed by all authors, who declare no conflict of interest.

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Additional information

This manuscript was presented as a scientific poster at the Annual Scientific Meeting of the American Society of Colon & Rectal Surgeons, June 10–14, 2017, Seattle, Washington.

What does this paper add to the literature?

This manuscript examines the relationship between computed tomography-derived measures of body fat distribution and morbidity and long-term oncologic outcomes after colectomy for cancer. This study seeks to overcome some of the drawbacks of prior studies of this subject. In our series, on multivariate analysis visceral fat area (VFA), but not BMI predicted morbidity following elective surgery for colon cancer. Neither VFA nor BMI was associated with overall or disease-free survival.

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Kuritzkes, B.A., Pappou, E.P., Kiran, R.P. 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 33, 1019–1028 (2018). https://doi.org/10.1007/s00384-018-3038-2

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  • DOI: https://doi.org/10.1007/s00384-018-3038-2

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