Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

In general, visceral fat and adhesion greatly influence the technical difficulty in performing abdominal surgery. Body mass index (BMI) has been widely used to express the degree of obesity, but it does not always properly reflect the degree of visceral fat. This retrospective study investigated the impact of visceral fat on the operation time to examine whether a quantified visceral fat area (VFA) could be used as a sensitive predictor of technical difficulty in performing a laparoscopic resection of rectosigmoid carcinoma.

Methods

Between February 1999 and April 2004, 58 consecutive patients underwent a laparoscopically assisted sigmoidectomy or anterior resection. After a review of the medical charts, the relationship between the operation time and the following variables was analyzed: sex, depth of invasion, approach (medial-to-lateral, lateral-to-medial), subjectively graded degree of visceral fat and adhesion, history of previous abdominal surgery, and BMI. The correlations between VFA, VFA/body surface area (BSA) measured by the “FatScan,” software package for quantifying the VFA from the preoperative CT images, and operation time were investigated. Next, the impact of the VFA amount on the early surgical outcome was examined.

Results

According to the intraoperative findings, two patients with a severe adhesion required a significantly longer operation time. A history of previous abdominal surgery was not a significant factor in the operation time. Instead, the VFA/BSA had a stronger correlation with the operation time than the BMI. A significantly longer operation time (209 ± 42 vs 179 ± 37 min; p = 0.031) was observed for the patients in the high VFA/BSA group (≥85 cm2/m2) group than in the normal VFA/BSA group (<85 cm2/m2).

Conclusion

For predicting the technical difficulty of performing a laparoscopic resection of rectosigmoid carcinoma, VFA/BSA may be a more useful index than BMI.

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.

Similar content being viewed by others

References

  1. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229

    Article  PubMed  Google Scholar 

  2. The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350: 2050–2059

    Article  Google Scholar 

  3. Leung KL, Kwok SPY, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 363: 1187–1192

    Article  PubMed  Google Scholar 

  4. Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer. is it beneficial for patients of heavier weight? Ann Surg 238: 680–685

    Article  PubMed  Google Scholar 

  5. Lee WJ, Wang W, Chen TC, Wei PL, Lin CM, Haung MT (2003) Clinical significance of central obesity in laparoscopic bariatric surgery. Obes Surg 13: 921–925

    Article  PubMed  Google Scholar 

  6. Ammori BJ, Vezakis A, Davides D, Martin IG, Larvin M, McMohon MJ (2001) Laparoscopic cholecystectomy in morbid obese patients. Surg Endosc 15: 1336–1339

    Article  PubMed  CAS  Google Scholar 

  7. National Institutes of Health Consensus Development Draft Conference Statement (1985) Health implications of obesity. Ann Intern Med 103: 1073–1077

    Google Scholar 

  8. Dindo D, Muller MK, Weber M, Clavien PA (2003) Obesity in general elective surgery. Lancet 361: 2032–2035

    Article  PubMed  Google Scholar 

  9. Bouchard C, Despres JP, Mauriege P (1993) Genetic and nongenetic determinants of regional fat distribution. Endocr Rev 14: 72–93

    Article  PubMed  CAS  Google Scholar 

  10. Bellisari A, Roche AF, Siervogel RM (1993) Reliability of B-mode ultrasonic measurements of subcutaneous adipose tissue and intraabdominal depth: comparisons with skinfold thicknesses. Int J Obes Metab Disord 17: 475–480

    CAS  Google Scholar 

  11. Suzuki R, Watanabe S, Hirai Y, Akiyama K, Nishide T, Matsushima Y, Ohshima H, Shinomiya M, Shirai K (1993) Abdominal wall fat index, estimated by ultrasonography, for assessment of the ratio of visceral fat to subcutaneous fat in the abdomen. Am J Med 95: 309–314

    Article  PubMed  CAS  Google Scholar 

  12. Seidell JC, Bakker CJ, van der Kooy K (1990) Imaging techniques for measuring adipose-tissue distribution: a comparison between computed tomography and 1.5-T magnetic resonance. Am J Clin Nutr 51: 953–957

    PubMed  CAS  Google Scholar 

  13. Ashwell M, Cole TJ, Dixon AK (1985) Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J 290: 1692–1694

    Article  CAS  Google Scholar 

  14. Kvist H, Chowdhury B, Grangard U, Tylen U, Sjostrom L (1988) Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 48: 1351–1361

    PubMed  CAS  Google Scholar 

  15. Svendsen OL, Hassager C, Bergmann I, Christiansen C (1993) Measurements of abdominal and intraabdominal fat in postmenopausal women by dual x-ray absorptiometry and anthropometry: comparison with computerized tomography. Int J Obes Relat Metab Disord 17: 45–51

    PubMed  CAS  Google Scholar 

  16. van der Kooy K, Seidell JC (1993) Techniques for the measurement of visceral fat: a practical guide. Int J Obes Relat Metab Disord 17: 187–196

    PubMed  Google Scholar 

  17. Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S (1983) A novel technique for the determination of body fat by computed tomography. Int J Obes 7: 437–445

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  19. 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: 283–286

    PubMed  CAS  Google Scholar 

  20. Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery: do we get faster? Surg Endosc 11: 331–335

    Article  PubMed  CAS  Google Scholar 

  21. Yamashita S, Nakamura T, Shimomura I, Nishida M, Yoshida S, Kotani K, Kameda-Takemuara K, Tokunaga K, Matsuzawa Y, (1996) Insulin resistance and body fat distribution. Diabetes Care 19: 1033–1034

    Article  Google Scholar 

  22. Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Tokunaga K (1995) Pathophysiology and pathogenesis of fat obesity. Ann N Y Acad Sci 748: 399–406

    Article  PubMed  CAS  Google Scholar 

  23. Shimomura I, Funahashi T, Takahashi M, Maeda K, Kotani K,Nakamura T, Yamashita S, Miura M, Fukuda Y, Takemura K, Tokunaga K, Matsuzawa Y, (1996) Enhanced expression of PAI-1 in visceral fat: possible contributor to vascular disease in obesity. Nat Med 2: 800–803

    Article  PubMed  CAS  Google Scholar 

  24. 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: 1261–1262

    Article  PubMed  CAS  Google Scholar 

  25. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46: 503–509

    Article  PubMed  Google Scholar 

  26. Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcome of laparoscopic left colectomy. Ann Surg 241: 69–76

    PubMed  Google Scholar 

  27. Lee CL, Wu CH, Chen TK, Lai YC, Yang SS, Huang CS, Chen DF (1993) Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy. J Clin Gastroenterol 16: 113–116

    Article  PubMed  CAS  Google Scholar 

  28. Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, Justin J, Schwartz J, Zaren HA (1994) Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 8: 871–874

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Drs. Tadashi Nakamura of Osaka University and Yuji Matsuzawa of Sumitomo Hospital for kindly providing valuable software and technical support.

Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan

    Y. Seki, M. Sekimoto, S. Takiguchi, I. Takemasa, M. Ikeda, H. Yamamoto & M. Monden

  2. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, 537-8511, Osaka, Japan

    M. Ohue

Authors
  1. Y. Seki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Ohue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Sekimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Takiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Takemasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Monden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Ohue.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seki, Y., Ohue, M., Sekimoto, M. et al. 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 (2007). https://doi.org/10.1007/s00464-006-9084-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-9084-9

Keywords

Search

Navigation