Visceral obesity, muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation

Heus, Colin; Cakir, Hamit; Lak, A.; Doodeman, Hiëronymus J.; Houdijk, Alexander P. J.

doi:10.1016/j.ijsu.2016.03.066

Cited by 35 publications

(47 citation statements)

References 27 publications

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“…Increased adipose tissue compartments, but not BMI or body weight, were positively correlated with the length of hospital stay, which was also seen by Tsujinaka et al[25], Chern et al[29], and Heus et al[28], who also observed a prolonged hospital stay in obese. Regarding surgery duration, weight, BMI, and all adipose tissue compartments were positively correlated, probably due to aggravated surgical conditions with reduced visibility.…”

Section: Discussionsupporting

confidence: 73%

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CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

Nattenmüller¹,

Böhm²,

Bagdassarjan³

et al. 2019

Obes Facts

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Purpose: Obesity is associated with increased incidence and mortality in rectal cancer (RC). However, an obesity paradox in the sense of a protective effect of obesity is discussed controversially. We evaluated whether adipose tissue distribution has an impact on medical (MC) and surgical complications (SC) after RC surgery. Methods: A total of 296 RC patients underwent oncological surgery and multidetector CT with quantification of total (TAT), visceral (VAT), and subcutaneous adipose tissue (SAT). Logistic regressions on SC (anastomotic leakage [n = 26], wound infection [n = 58], bleeding [n = 12], abscess [n = 32], bladder dysfunction [n = 24], burst abdomen [n = 10]), and MC (pulmonary [n = 22], cardiac [n = 18], urinary tract infection [n = 9], sepsis [n = 5]) were performed. Results: High pelvicVAT was associated with reduced risk for overall SC (OR = 0.915, p = 0.012) and anastomotic leakage (OR = 0.587, p = 0.024, CI: 0.369/0.934). In contrast, CT-quantified obesity was associated with increased risk for wound infection, bladder dysfunction, burst abdomen, overall MC, and cardiac complications (ORs up to 1.423). BMI was not associated with any SC or MC. Conclusion: An obesity paradox with a protective effect of CT-quantified adipose tissue was confirmed for anastomotic leakage and overall SC. In contrast, high adipose tissue was associated with higher risk for other SC and MC. These results show a more complex influence of body composition on MC and SC. CT-quantified obesity is able to provide deeper insights to explain the obesity paradox beyond BMI.

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Section: Discussionsupporting

confidence: 73%

“…There was no significant correlation of blood loss with any adipose tissue compartment as well as weight or BMI. In contrast, in a study by Heus et al [28], high VAT was associated with high perioperative blood loss.…”

Section: Discussionmentioning

confidence: 74%

CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

Nattenmüller¹,

Böhm²,

Bagdassarjan³

et al. 2019

Obes Facts

View full text Add to dashboard Cite

show abstract

“…A few previous studies have included stage IV colorectal cancers with hepatic metastasis . One study included rectal cancer surgical patients after neoadjuvant chemoradiation therapy, but it only analysed perioperative outcomes without long‐term oncologic outcomes …”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, 100 and 130 cm 2 were used as cut‐offs . In our study, we defined visceral obesity with area of visceral fat >100 cm 2 …”

Section: Methodsmentioning

confidence: 99%

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Sarcopenia is negatively associated with long‐term outcomes in locally advanced rectal cancer

Choi

Lee

et al. 2017

J cachexia sarcopenia muscle

136

140

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BackgroundThe association of sarcopenia and visceral obesity to treatment outcome is not clear for locally advanced rectal cancer. This study evaluates the influence of skeletal muscle and visceral fat on short‐term and long‐term outcomes in locally advanced rectal cancer patients treated with neoadjuvant chemoradiation therapy followed by curative resection.MethodsA total of 188 patients with locally advanced cancer were included between January 2009 and December 2013. Neoadjuvant chemoradiotherapy was followed by curative resection. Sarcopenia and visceral obesity were identified in initial staging CT by measuring the muscle and visceral fat area at the third lumbar vertebra level.ResultsAmong the 188 included patients, 74 (39.4%) patients were sarcopenic and 97 (51.6%) patients were viscerally obese. Sarcopenia and high levels of preoperative carcinoembryonic antigen were significant prognostic factors for overall survival (P = 0.013, 0.014, respectively) in the Cox regression multivariate analysis. Visceral obesity was not associated with overall survival; however, it did tend to shorten disease‐free survival (P = 0.079).ConclusionsSarcopenia is negatively associated with overall survival in locally advanced rectal cancer patients who underwent neoadjuvant chemoradiation therapy and curative resection. Visceral obesity tended to shorten disease‐free survival. Future studies should be directed to optimize patient conditions according to body composition status.

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The impact of low muscle mass on prognosis following neoadjuvant chemotherapy for resectable locally advanced rectal cancer: a systematic review and meta‐analysis

Hatt

Smart

Hardy

et al. 2023

JCSM Clinical Reports

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Background Sarcopenia is characterized by the progressive and generalized loss of muscle mass and function. There is an increasing body of evidence to suggest that cancer patients with pre-existing sarcopenia are at a greater risk of both short-and long-term clinical complications. The aim of this review is to examine the impact of low muscle mass on prognostic outcomes in patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) prior to surgery. Methods MEDLINE, PubMed, and Embase databases were searched from inception to October 2021. Any comparative studies relating to the prognostic outcomes of sarcopenic versus non-sarcopenic patients with LARC who received nCRT prior to surgery were included. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was performed on reported hazard ratios (HR) and 95% confidence intervals (CI) using DerSimonian-Laird random-effects models. Results A total of 598 patients from five studies were included in the analysis of hazard ratios for overall survival, whereas 505 patients from four studies were available for analysis of HR for disease-free survival. Meta-regression analysis showed a significant association between pre-existing sarcopenia and worse overall survival (HR: 1.69, 95% CI: 1.15-2.48). The association between pre-existing sarcopenia and shorter disease-free survival was not statistically significant (HR: 1.07, 95% CI: 0.63-1.82). Conclusions The review highlights the role that body composition can play on prognostic outcomes in patients undergoing multimodal cancer treatment. Given the complex underpinnings of sarcopenia progression, more research is needed to develop strategies to mitigate this impact in a physiologically vulnerable population.

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Visceral obesity, muscle mass and outcome in rectal cancer surgery after neo-adjuvant chemo-radiation

Abstract: It appears that VO is associated with co-morbidity and poor outcome in rectal cancer patients. Using different cutoff values for VO different associations with outcome were found. SMA increased during chemoradiation, a phenomenon that remains to be explained.

Cited by 35 publications

References 27 publications

CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

Sarcopenia is negatively associated with long‐term outcomes in locally advanced rectal cancer

The impact of low muscle mass on prognosis following neoadjuvant chemotherapy for resectable locally advanced rectal cancer: a systematic review and meta‐analysis

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