Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New Zealand

Phillip F Yang1, Zhen Hao Ang2,1, Sarit Badiani1, Christophe R Berney1,2, Matthew J. Morgan2,1
1South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
2Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, Australia

Tóm tắt

Abstract Purpose

Patients with obesity undergoing rectal cancer surgery may have an increased risk of developing complications, though evidence is inconclusive. The aim of this study was to determine the direct impact of obesity on postoperative outcomes using data from a large clinical registry.

Method

The Binational Colorectal Cancer Audit registry was used to identify patients who underwent rectal cancer surgery in Australia and New Zealand from 2007–2021. Primary outcomes were inpatient surgical and medical complications. Logistic regression models were developed to describe the association between body-mass index (BMI) and outcomes.

Results

Among 3,708 patients (median age 66 years [IQR 56.75–75], 65.0% male), 2.0% had a BMI < 18.5 kg/m2, 35.4% had a BMI of 18.5–24.9 kg/m2, 37.6% had a BMI of 25.0–29.9 kg/m2, 16.7% had a BMI of 30.0–34.9 kg/m2, and 8.2% had a BMI ≥ 35.0 kg/m2. Surgical complications occurred in 27.7% of patients with a BMI of 18.5–24.9 kg/m2, 26.6% of patients with a BMI of 25.0–29.9 kg/m2 (OR 0.91, 95% CI 0.76–1.10), 28.5% with a BMI of 30.0–34.9 kg/m2 (OR 0.96, 95% CI 0.76–1.21), and 33.2% with a BMI ≥ 35.0 kg/m2 (OR 1.27, 95% CI 0.94–1.71). Modelling BMI as a continuous variable confirmed a J-shaped relationship. The association between BMI and medical complications was more linear.

Conclusion

Risk of postoperative complications is increased in patients with obesity undergoing rectal cancer surgery.

Từ khóa


Tài liệu tham khảo

Australian Institute of Health and Welfare (2020) Overweight and obesity. Canberra: AIHW. [Cited 2022 Aug 12]. Available from: https://www.aihw.gov.au/reports/australias-health/overweight-and-obesity

Ministry of Health (2021) Annual Data Explorer 2020/21: New Zealand Health Survey (Data File). [Cited 2022 Aug 12]. Available from: https://minhealthnz.shinyapps.io/nz-health-survey-2020-21-annual-data-explorer/

Bell S, Kong JC, Wale R et al (2018) The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Dis 20:778–788

Duchalais E, Machairas N, Kelley SR et al (2018) Does obesity impact postoperative outcomes following robotic-assisted surgery for rectal cancer? Surg Endosc 32:4886–4892

Heus C, Cakir H, Lak A, Doodeman HJ, Houdijk AP (2016) Visceral obesity, muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation. Int J Surg 29:159–164

Berkel AEM, Klaase JM, de Graaff F, Brusse-Keizer MGJ, Bongers BC, van Meeteren NLU (2019) Patient’s skeletal muscle radiation attenuation and sarcopenic obesity are associated with postoperative morbidity after neoadjuvant chemoradiation and resection for rectal cancer. Dig Surg 36:376–383

Jochum SB, Kistner M, Wood EH et al (2019) Is sarcopenia a better predictor of complications than body mass index? Sarcopenia and surgical outcomes in patients with rectal cancer. Colorectal Dis 21:1372–1378

Giani A, Famularo S, Riva L et al (2020) Association between specific presurgical anthropometric indexes and morbidity in patients undergoing rectal cancer resection. Nutrition 75–76:110779

Zhou CJ, Cheng YF, Xie LZ et al (2020) Metabolic syndrome, as defined based on parameters Including visceral fat area, predicts complications after surgery for rectal cancer. Obes Surg 30:319–326

Balentine CJ, Wilks J, Robinson C et al (2010) Obesity increases wound complications in rectal cancer surgery. J Surg Res 163:35–39

Bokey L, Chapuis PH, Dent OF (2014) Impact of obesity on complications after resection for rectal cancer. Colorectal Dis 16:896–906

Aytac E, Lavery IC, Kalady MF, Kiran RP (2013) Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum 56:689–697

Baastrup NN, Christensen JK, Jensen KK, Jorgensen LN (2020) Visceral obesity and short-term outcomes after laparoscopic rectal cancer resection. Surg Endosc 34:177–185

Bayraktar O, Aytac E, Ozben V et al (2018) Does robot overcome obesity-related limitations of minimally invasive rectal surgery for cancer? Surg Laparosc Endosc Percutan Tech 28:e8–e11

Peacock O, Limvorapitak T, Hu CY et al (2020) Robotic rectal cancer surgery: comparative study of the impact of obesity on early outcomes. Br J Surg 107:1552–1557

Pai A, Alsabhan F, Park JJ, Melich G, Sulo S, Marecik SJ (2017) The impact of obesity on the perioperative, clinicopathologic, and oncologic outcomes of robot assisted total mesorectal excision for rectal cancer. Pol Przegl Chir 89(4):23–28

Makino T, Trencheva K, Shukla PJ et al (2014) The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery 156:661–668

Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Kirbiyik E (2011) Impact of increased body mass index on laparoscopic surgery for rectal cancer. Eur Surg Res 46:87–93

Bege T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero JR (2009) Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 23:1460–1464

Crippa J, Grass F, Achilli P et al (2020) Risk factors for conversion in laparoscopic and robotic rectal cancer surgery. Br J Surg 107:560–566

Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E (2013) Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis 15:463–469

Son IT, Kim DW, Choe EK et al (2019) Oncologic evaluation of obesity as a factor in patients with rectal cancer undergoing laparoscopic surgery: a propensity-matched analysis using body mass index. Ann Surg Treat Res 96:86–94

Chern H, Chou J, Donkor C et al (2010) Effects of obesity in rectal cancer surgery. J Am Coll Surg 211:55–60

Gebauer B, Meyer F, Ptok H et al (2017) Impact of body mass index on early postoperative and long-term outcome after rectal cancer surgery. Visc Med 33:373–382

Poelemeijer YQM, Lijftogt N, Detering R, Fiocco M, Tollenaar R, Wouters M (2018) Obesity as a determinant of perioperative and postoperative outcome in patients following colorectal cancer surgery: a population-based study (2009–2016). Eur J Surg Oncol 44:1849–1857

Smith RK, Broach RB, Hedrick TL, Mahmoud NN, Paulson EC (2014) Impact of BMI on postoperative outcomes in patients undergoing proctectomy for rectal cancer: a national surgical quality improvement program analysis. Dis Colon Rectum 57:687–693

Hrabe JE, Sherman SK, Charlton ME, Cromwell JW, Byrn JC (2014) Effect of BMI on outcomes in proctectomy. Dis Colon Rectum 57:608–615

Hirpara DH, O’Rourke C, Azin A, Quereshy FA, Wexner SD, Chadi SA (2022) Impact of BMI on adverse events after laparoscopic and open surgery for rectal cancer. J Gastrointest Cancer 53:370–379

Sweigert PJ, Chen C, Fahmy JN et al (2020) Association of obesity with postoperative outcomes after proctectomy. Am J Surg 220:1004–1009

Hunter RA, Moore J, Committee BO (2016) Evolution of the Bi-National Colorectal Cancer Audit: history, governance and future directions. ANZ J Surg 86:431–432

Dagher H, Ahern S, Egwunye J et al (2021) Binational colorectal cancer audit: 2020 data audit report. [Cited 2022 Aug 12]. Available from: https://www.monash.edu/__data/assets/pdf_file/0010/2652661/bcca-2020-report.pdf

Bennette C, Vickers A (2012) Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. BMC Med Res Methodol 12:21

Hopf HW, Hunt TK, West JM et al (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997–1004

Tanaka S, Inoue S, Isoda F et al (1993) Impaired immunity in obesity: suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord 17:631–636

Anaya DA, Dellinger EP (2006) The obese surgical patient: a susceptible host for infection. Surg Infect (Larchmt) 7:473–80

Edmiston CE, Krepel C, Kelly H et al (2004) Perioperative antibiotic prophylaxis in the gastric bypass patient: do we achieve therapeutic levels? Surgery 136:738–747

Hannan E, Kelly ME, Fahy MR, Winter DC (2022) Prehabilitation in rectal surgery: a narrative review. Int J Colorectal Dis 37:293–299

Bell S, Venchiarutti R, Warrier S, Stevenson A, Solomon M (2019) Perspectives on surgical randomized controlled trials. ANZ J Surg 89:998–999