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Elevated visceral obesity quantified by CT is associated with adverse postoperative outcome of laparoscopic radical nephrectomy for renal clear cell carcinoma patients

  • Urology - Original Paper
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Abstract

Purpose

To examine the association between CT measures of visceral obesity and short-term postoperative outcomes in renal clear cell carcinoma (RCCC) patients.

Methods

In this retrospective study, 76 patients treated with unilateral laparoscopic radical nephrectomy for stage I–III renal cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity [obese: visceral fat area (VFA) > 100 cm2, BMI ≥ 28 kg/m2]. Clinical variables, Fuhrman grade, operation time, estimated blood loss (EBL), postoperative complications, postoperative stay, drainage time and hospitalization expenses were compared between the two groups.

Results

Viscerally obese patients significantly had higher Fuhrman grade than the non-obese (p = 0.018). The operation time of obese patients by VFA or BMI was more than the non-obese (171.6 ± 68.9 vs. 140.8 ± 35.5 min, p = 0.012 and 197.2 ± 67.2 vs. 153.2 ± 57.7 min, p = 0.013, respectively). And obese patients by VFA or BMI tended to have more EBL than non-obese (132.0 ± 120.7 vs. 83.8 ± 53.4 ml, p = 0.018 and 215.3 ± 165.0 vs. 92.5 ± 68.8 ml, p = 0.013, respectively). Viscerally obese patients by VFA (not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese: VFA (26.9 vs. 4.2%, p = 0.045) and BMI (33.3 vs. 16.4%, p =0.265). Furthermore, obese patients by VFA (not BMI) were more likely to have longer postoperative stay: VFA (8.7 ± 2.5 vs. 7.5 ± 1.4 dollars, p = 0.013) and BMI (9.1 ± 2.9 vs. 8.1 ± 2.1 dollars, p = 0.209). Obese patients expensed more than non-obese: VFA (7570.9 ± 2674.3 vs. 6368.8 ± 1289.8 dollars, p = 0.040) and BMI (8390.8 ± 2929.7 vs. 6896.3 ± 2159.1 dollars, p = 0.029).

Conclusions

Elevated visceral obesity by VFA is associated with increased surgical complexity, postoperative morbidity, postoperative stay and hospitalization expenses for RCCC patients and may be superior to BMI for renal cancer outcome assessment. VFA may be a useful index for the evaluation and calculation of RCCC aggressiveness.

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References

  1. Ozoya OO, Siegel EM, Srikumar T et al (2017) Quantitative assessment of visceral obesity and postoperative colon cancer outcomes. Gastrointest Surg 21(3):534–542

    Article  Google Scholar 

  2. Yuge K, Miyajima A, Jinzaki M et al (2015) How does visceral obesity affect surgical performance in laparoscopic radical nephrectomy? Jpn J Clin Oncol 45(4):373–377

    Article  PubMed  Google Scholar 

  3. Keehn A, Srivastava A, Maiman R et al (2015) The relationship between visceral obesity and the clinicopathologic features of patients with small renal masses. J Endourol 29(3):372–376

    Article  PubMed  Google Scholar 

  4. Irving BA, Weltman JY, Brock DWNIH et al (2007) ImageJ and Slice-O-Matic computed tomography imaging software to quantify soft tissue. Obesity (Silver Spring) 15(2):370–376

    Article  Google Scholar 

  5. Sobin LH, Gospodariwicz M, Wittekind C (eds) (2009) TNM classification of malignant tumors. UICC International Union Against Cancer, vol 7. Wiley-Blackwell, Hoboken, p 255

    Google Scholar 

  6. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jeong IG, Khandwala YS, Kim JH et al (2017) Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. JAMA 318(16):1561–1568

    Article  PubMed  PubMed Central  Google Scholar 

  8. Finnerty CC, Mabvuure NT, Ali A et al (2013) The surgically induced stress response. JPEN J Parenter Enteral Nutr 37(5 Suppl):21S–29S

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tewari N, Awad S, Macdonald IA, Lobo DN (2015) Obesity-related insulin resistance: implications for the surgical patient. Int J Obes (Lond) 39(11):1575–1588

    Article  CAS  Google Scholar 

  10. Harvey AE, Lashinger LM, Hursting SD (2011) The growing challenge of obesity and cancer: an inflammatory issue. Ann N Y Acad Sci 1229:45–52

    Article  CAS  PubMed  Google Scholar 

  11. Klöting N, Fasshauer M, Dietrich A et al (2010) Insulin-sensitive obesity. Am J Physiol Endocrinol Metab 299(3):E506–E515

    Article  PubMed  Google Scholar 

  12. Ye J, Gao Z, Yin J et al (2007) Hypoxia is a potential risk factor for chronic inflammation and adiponectin reduction in adipose tissue of ob/ob and dietary obese mice. Am J Physiol Endocrinol Metab 293(4):E1118–E1128

    Article  CAS  PubMed  Google Scholar 

  13. Qin L, Wang Z, Tao L et al (2010) ER stress negatively regulates AKT/TSC/mTOR pathway to enhance autophagy. Autophagy 6(2):239–247

    Article  CAS  PubMed  Google Scholar 

  14. Pecorelli N, Carrara G, DeCobelli F et al (2016) Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. Br J Surg 103(4):434–442

    Article  CAS  PubMed  Google Scholar 

  15. Hagiwara M, Miyajima A, Hasegawa M et al (2012) Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy. BJU Int 110(11 Pt C):E980-4

    PubMed  Google Scholar 

  16. Ioffe E, Hakimi AA, Sk O et al (2013) Effect of visceral obesity on minimally invasive partial nephrectomy. Urology 82(3):612–618

    Article  PubMed  Google Scholar 

  17. Zhu Y, Wang HK, Zhang HL et al (2013) Visceral obesity and risk of high grade disease in clinical t1a renal cell carcinoma. J Urol 189(2):447–453

    Article  PubMed  Google Scholar 

  18. Kato M, Suzuki T, Suzuki Y et al (2004) Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol 172:863

    Article  PubMed  Google Scholar 

  19. Guðmundsson E, Hellborg H, Lundstam S et al (2011) Metastatic potential in renal cell carcinomas ≤ 7 cm: Swedish kidney cancer quality register data. Eur Urol 60:975

    Article  PubMed  Google Scholar 

  20. Khandekar MJ, Cohen P, Spiegelman BM et al (2011) Molecular mechanisms of cancer development in obesity. Nat Rev Cancer 11:886

    Article  CAS  PubMed  Google Scholar 

  21. Cao Y (2007) Angiogenesis modulates adipogenesis and obesity. J Clin Invest 117:2362–2368

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ladoire S, Bonnetain F, Gauthier M et al (2011) Visceral fat area as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with antiangiogenic agents. Oncologist 16:71–81

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yerlikaya A, Dagel T, King C et al (2017) Dietary and commercialized fructose: Sweet or sour? Int Urol Nephrol 49:1611

    Article  CAS  PubMed  Google Scholar 

  24. Kadowaki T, Sekikawa A, Murata K et al (2006) Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes (Lond) 30:1163

    Article  CAS  Google Scholar 

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Acknowledgements

Tingshuai Zhai contributed to study design, data collection, analysis, and writing. Bocheng Zhang involved in data collection, design, and writing. Zhenan Qu and Chen Chen contributed to data collection and design. Tingshuai Zhai thanks the care and guidance of Dr. Weizheng Mao, Dr. Bo Jiang and Dr. Sichuan Hou.

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Authors and Affiliations

  1. Dalian Medical University, Dalian, 116044, Liaoning, China

    Tingshuai Zhai, Bocheng Zhang, Zhenan Qu & Chen Chen

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  1. Tingshuai Zhai
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  2. Bocheng Zhang
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Correspondence to Tingshuai Zhai.

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Zhai, T., Zhang, B., Qu, Z. et al. Elevated visceral obesity quantified by CT is associated with adverse postoperative outcome of laparoscopic radical nephrectomy for renal clear cell carcinoma patients. Int Urol Nephrol 50, 845–850 (2018). https://doi.org/10.1007/s11255-018-1858-1

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  • DOI: https://doi.org/10.1007/s11255-018-1858-1

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