Impact of Body Composition on Surgical Outcome in Rectal Cancer Patients, a Retrospective Cohort Study

Abstract

Background Obesity is becoming a bigger health problem every year. Current research shows that the obesity-related metabolic problems are strongly associated with visceral fat and not subcutaneous fat. Visceral obesity (VO) is associated with a worse postoperative outcome in multiple fields of abdominal surgery. On the other hand, muscle mass is related to better postoperative outcome. In rectal cancer patients, we studied the influence of visceral obesity and muscle mass on postoperative complications. Methods The visceral fat area (VFA) and skeletal muscle area (SMA) were determined on preoperative CT scans in 406 patients. The preoperative comorbidity, per-operative outcome and postoperative complications were extracted retrospectively from the patient files. VO was defined as a VFA [ 100 cm 2 . Correlations between body composition, postoperative complications and LOS were studied. Results In our study, 67% of the patients were classified as visceral obese. Mean body mass index (BMI) was higher in the VO group (26.6 ± 3.5 vs 23.5 ± 2.8; p \ 0.001). Visceral obese patients had a higher prevalence of cardiac comorbidity (29% vs 13% p = 0.001), hypertension (36% vs 20% p = 0.002) and diabetes mellitus (16% vs 5% p = 0.002). In addition, VO patients had more operative blood loss (431 vs 310 mL; p = 0.008), longer operating time (166 vs 149 min p = 0.003) and more wound infections (14% vs 8% p = 0.048). Visceral obesity was associated with more complications (OR: 1.63 p = 0.043) and longer LOS (risk estimate: 1.18 p = 0.009). Conclusion VO patients more often had a history of cardiac disease, hypertension and diabetes mellitus. Visceral obesity correlated with a worse outcome after surgery for rectal cancer.

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

“…The same counts for VAT or visceral obesity, which was found to be associated with postoperative complications , LOS , readmission , and 2‐year survival in some studies. However, in other studies, associations with overall postoperative complications , LOS , readmission , dose‐limiting toxicity , and long‐term survival were not found. The use of cutoff points and inclusion of all age groups could have contributed to the inconsistency of these results.…”

“…Low muscle density has been associated with postoperative complications and long‐term survival , although other studies have found no associations with overall or severe postoperative complications and long‐term survival . The same counts for VAT or visceral obesity, which was found to be associated with postoperative complications , LOS , readmission , and 2‐year survival in some studies. However, in other studies, associations with overall postoperative complications , LOS , readmission , dose‐limiting toxicity , and long‐term survival were not found.…”

“…Low SM has been shown to be associated with severe postoperative complications , LOS , dose‐limiting toxicity , and long‐term survival . However, other studies did not show associations between low SM and overall or severe postoperative complications , readmission , and long‐term survival . These varying results may have been caused by the use of different cutoff points, limiting comparison of studies.…”

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

“…However, within urology most prehabilitation studies have focussed upon reducing specific urological complications (e.g. urinary incontinence) [16] and not on general physiological parameters known to be associated with improved post-operative outcomes and return to preoperative status such as CRF [14], skeletal muscle mass [17] and body composition [18]. One consideration for all cancer prehabilitation regimes largely regardless of endpoint is that in the UK, the National Cancer Action Team specifies that first treatment (including surgery) should start within 31 days of the decision to treat [19].…”

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

“…PMI is a simple but reliable method of prognostic evaluation similar to SOFA. Body composition has recently been reported as a risk factor or prognostic factor for postoperative complications [3,5,24,25] early introduction of aggressive blood purification and medication may be necessary in the muscle loss group. In this study, the number of cases was limited because of the single-center design, and the ability to conduct sufficient studies appears limited.…”