Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

Hughes, Tasha M.; Shah, Kejal; Noria, Sabrena; Pawlik, Timothy M.

doi:10.1002/jso.24999

Cited by 15 publications

(14 citation statements)

References 130 publications

(621 reference statements)

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“…Patients with extremely high BMI have more subcutaneous fat and thicker fat layer. Obesity may adversely affect surgical outcomes in patients after major abdominal surgery owing to limited field of view, operation difficulties during surgeries and co-morbidities ( 4 , 38 ). Obese patients may also be exposed to inadequate lymph node dissection and increased intraoperative complications ( 4 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis

Cai

Kang

2022

Front. Oncol.

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BackgroundThe impact of obesity on the surgical outcomes in patients after primary ovarian cancer surgery is unclear. We aimed at conducting a meta-analysis to evaluate the associations between obesity and major surgical outcomes in ovarian cancer patients.MethodEmbase, PubMed and Web of Science databases were searched for eligible studies. Study-specific relative risks (RR) were pooled using fixed effect model when little evidence of heterogeneity was detected, otherwise random effect model was employed.ResultsTwelve eligible studies were identified. The pooled incidence rates of all complications were 38% (95% CI: 29%, 47%) for obese patients and 27% (95% CI: 18%, 36%) for non-obese patients. Compared with the non-obese patients, there was a significantly increased risk of all complications in obese patients after ovarian cancer surgery, with a pooled RR of 1.75 (95% CI: 1.26, 2.43). For advanced (stages III–IV) ovarian cancer, the pooled RR of all complications was 1.55 (95% CI: 1.07, 2.24). Obese patients after ovarian cancer surgery were at higher risks of wound complication (pooled RR: 7.06, 95% CI: 3.23, 15.40) and infection (pooled RR: 1.94, 95% CI: 1.47, 2.55) compared with non-obese patients. Such increased risk was not observed for other major complications, namely, venous thromboembolism, ileus and organ failure. Hospital stay days between obese patients and non-obese patients were similar (Standardized Mean Difference: −0.28, 95% CI: −0.75, 0.19). The rates of optimal debulking (pooled RR: 0.96, 95% CI: 0.90, 1.03), readmission/return to operation room (pooled RR: 1.20, 95% CI: 0.56, 2.57) and 30-day mortality (pooled RR: 0.95, 95% CI: 0.54, 1.66) were also comparable between obese patients and non-obese patients.ConclusionObesity is associated with an increased risk of postoperative complications, especially wound complications and infection after primary ovarian cancer surgery. Obesity may not affect their optimal debulking rates and 30-day mortality in patients undergoing ovarian cancer surgery. Besides, to improve surgical outcomes, an advanced minimally invasive robotic approach seems to be feasible for the treatment of obese patients with ovarian cancer.

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Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis

Cai

Kang

2022

Front. Oncol.

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“…Overweight and obese patients often show higher rates of mortality and morbidity after RC compared to those of normal BMI, likely due to increased perioperative blood loss and prolonged operative times for overweight individuals [24]. Pulmonary compromise due to the Trendelenburg position and abdominal pressure on the diaphragm may also lead to an increased risk of pneumonia, heart failure, deep venous thrombosis, and pulmonary embolism in these patients [25]. Such patients may also be at increased risk of infections and impaired wound closure after RC [26].…”

Section: Discussionmentioning

confidence: 99%

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Adamczyk¹,

Pobłocki²,

Kadłubowski³

et al. 2021

Urol Int

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Purpose: This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. Methods: A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). Results: The surgical technique was significantly related to the number of complications (p < 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (p < 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (p < 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. Conclusions: The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

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“…Hughes et al recently reported a signi cant difference in the overall complication incidence of obese patients and nonobese patients after major abdominal surgery in gastric, rectal and liver cancers [5]. Apart from increasing di culties during cytoreductive surgery, obesity may also contribute to more postoperative complications and higher costs [6].…”

Section: Introductionmentioning

confidence: 99%

Visceral Obesity Determined by CT As a Predictor of Short-term Postoperative Complications in Ovarian Cancer

Nie

Zhang

Meng

et al. 2022

Preprint

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Objective: To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.Methods: Medical records were reviewed for patients with ovarian cancer. Visceral fat area, subcutaneous fat area and total fat area were measured on a single slice at the level of L3/4 of a preoperative CT scan. Univariable and multivariable analyses were performed to investigate the correlation between visceral obesity and short-term complications and to analyze the risk factors for complications after surgery.Results: Of the 130 patients, 53.8% (70/130) were presented visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.3 years old vs. 52.3 years old, p = 0.001). The proportion of patients with hypertension was slightly higher (37.1% vs. 11.7%, p = 0.001). The total fat area and subcutaneous fat area were higher in patients with visceral obesity (296.9 ± 72.1 vs. 173.1 ± 67.3, p < 0.001; 168.8 ± 55.5 vs. 121.6 ± 54.3, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). Time from surgery to adjuvant chemotherapy for patients with visceral obesity has been delayed (24 days vs. 20 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR 4.770, p < 0.001) and operation time (OR 1.008, p < 0.001) were independent predictors of postoperative complications. Conclusion: Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

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Is BMI associated with post‐operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review

Cited by 15 publications

References 130 publications

Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis

Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Visceral Obesity Determined by CT As a Predictor of Short-term Postoperative Complications in Ovarian Cancer

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