Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes

Abstract

Background Quantitative computed tomography (CT) assessment of visceral adiposity may be superior to body mass index (BMI) as a predictor of surgical morbidity. We sought to examine the association of CT measures of obesity and BMI with short-term post-operative outcomes in colon cancer patients. Methods In this retrospective study, 110 patients treated with colectomy for Stage I–III colon cancer were classified as obese or non-obese by pre-operative CT-based measures of adiposity or BMI. [Obese: BMI≥30kg/m2, visceral fat area (VFA) to subcutaneous fat area ratio (V/S) ≥0.4 and VFA>100cm2)]. Post-operative morbidity and mortality rates were compared. Results Obese patients, by V/S and VFA but not BMI, were more likely to be male and have pre-existing hypertension and diabetes. The overall complication rate was 25.5% and there were no mortalities. Obese patients by VFA (with a trend for VS but not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese; VFA (30.5% vs.10.7%, p= 0.03), VS (29.2% vs. 9.5%, p=0.05) and BMI (32.4% vs. 21.9%, p=0.23). Conclusions Elevated visceral obesity quantified by CT is associated with the presence of key metabolic comorbidities and increased post-operative morbidity and may be superior to BMI for risk stratification.

Elevated visceral fat area is associated with adverse postoperative outcome of radical colectomy for colon adenocarcinoma patients

“…There was no significant difference in tumour location and surgical approach between the obese group and the non‐obese group, excluding the influence of such interference factors. Among the three obesity indicators (BMI, V/S, VFA), only higher VFA was associated with elevated risk of complications, which was consistent with the study performed at the Moffitt Cancer Center . Findings about BMI's value in predicting surgical outcomes are often contradictive and inconclusive, which may due to the limitation that BMI does not account for the specific distribution of body fat.…”

“…Commonly used measurements for visceral obesity includes VFA and V/S. VFA ≥100 cm 2 or V/S ≥0.4 is selected to define visceral obesity . About 107 patients were classified as obese or non‐obese by BMI, V/S and VFA, respectively.…”

“…Findings about the relationship between BMI and postoperative outcomes in the literature are often contradictive and inconclusive . Instead, computed tomography (CT) and magnetic resonance imaging can accurately assess the distribution of visceral fat and detect visceral obesity . Here, we further investigate the association between pretreatment CT measures of visceral adiposity and short‐term surgical outcomes compared with BMI in a relatively homogeneous group of stage I–III colon adenocarcinoma patients undergoing radical surgery.…”

“…It has been suggested that corporeity may influence short‐term surgical outcomes in addition to surgical techniques and perioperative care protocols. Recent studies have emphasized the influence of visceral obesity on perioperative and short‐term postoperative outcomes in patients surgically treated . Body mass index (BMI), considered as a conventional tool to assess obesity, can be easily calculated, but it cannot estimate body fat distribution accurately .…”

Association between Higher Body Mass Index and Pouch-Related Complications during Restorative Proctocolectomy in Patients with Ulcerative Colitis

“…Tanaka et al [18] reported that Japanese have lower BMIs than Caucasians, though Japanese have a significantly greater amount of abdominal visceral fat compared with Caucasians after adjusting for age, sex, and abdominal subcutaneous fat. There have been reports that visceral obesity is a more accurate predictor of perioperative complications than BMI in patients with colon cancer, and patients classified as obese by visceral fat area had significantly higher incidence and overall complication rates compared with nonobese patients [19,20]. Visceral fat has been reported to be a predictive factor for postoperative complications in CD [21].…”