Effect of obesity on post-operative outcomes following colorectal cancer surgery

Abstract

BACKGROUND Colorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery. AIM To evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery. METHODS Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [ n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)]. RESULTS Obese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07). CONCLUSION Surgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.

Single-incision plus one-port laparoscopy surgery versus conventional multi-port laparoscopy surgery for colorectal cancer: a systematic review and meta-analysis

“…This is because obesity is an independent risk factor for postoperative complications following laparoscopic right hemicolectomy [ 40 ]. Additionally, obesity (BMI > 30.0 kg/m 2 ) is associated with increased cardiovascular burden, respiratory complications, as well as higher rates of conversion to open surgery and postoperative complications [ 41 ].…”

The impact of operative approach for obese colorectal cancer patients: analysis of the National Inpatient Sample 2015–2019

“…Multiple studies have shown that a higher BMI predicts worse outcomes in colorectal surgery [13,14]. This is attributed to both the increased technical challenges as well as associated physiological alterations leading to increased intraoperative and postoperative complications [15][16][17][18]. Despite the improved operative and anaesthetic techniques, some controversy still exists as to whether MIS leads to similar improvements in outcomes in the obese patient population as in the nonobese population [15,16,19].…”