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Surgical Endoscopy

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01-06-2007

Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index

Authors: Y. Seki, M. Ohue, M. Sekimoto, S. Takiguchi, I. Takemasa, M. Ikeda, H. Yamamoto, M. Monden

Published in: Surgical Endoscopy | Issue 6/2007

Abstract

Background

In general, visceral fat and adhesion greatly influence the technical difficulty in performing abdominal surgery. Body mass index (BMI) has been widely used to express the degree of obesity, but it does not always properly reflect the degree of visceral fat. This retrospective study investigated the impact of visceral fat on the operation time to examine whether a quantified visceral fat area (VFA) could be used as a sensitive predictor of technical difficulty in performing a laparoscopic resection of rectosigmoid carcinoma.

Methods

Between February 1999 and April 2004, 58 consecutive patients underwent a laparoscopically assisted sigmoidectomy or anterior resection. After a review of the medical charts, the relationship between the operation time and the following variables was analyzed: sex, depth of invasion, approach (medial-to-lateral, lateral-to-medial), subjectively graded degree of visceral fat and adhesion, history of previous abdominal surgery, and BMI. The correlations between VFA, VFA/body surface area (BSA) measured by the “FatScan,” software package for quantifying the VFA from the preoperative CT images, and operation time were investigated. Next, the impact of the VFA amount on the early surgical outcome was examined.

Results

According to the intraoperative findings, two patients with a severe adhesion required a significantly longer operation time. A history of previous abdominal surgery was not a significant factor in the operation time. Instead, the VFA/BSA had a stronger correlation with the operation time than the BMI. A significantly longer operation time (209 ± 42 vs 179 ± 37 min; p = 0.031) was observed for the patients in the high VFA/BSA group (≥85 cm²/m²) group than in the normal VFA/BSA group (<85 cm²/m²).

Conclusion

For predicting the technical difficulty of performing a laparoscopic resection of rectosigmoid carcinoma, VFA/BSA may be a more useful index than BMI.

Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229PubMedCrossRef

The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350: 2050–2059CrossRef

Leung KL, Kwok SPY, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 363: 1187–1192PubMedCrossRef

Noshiro H, Shimizu S, Nagai E, Ohuchida K, Tanaka M (2003) Laparoscopy-assisted distal gastrectomy for early gastric cancer. is it beneficial for patients of heavier weight? Ann Surg 238: 680–685PubMedCrossRef

Lee WJ, Wang W, Chen TC, Wei PL, Lin CM, Haung MT (2003) Clinical significance of central obesity in laparoscopic bariatric surgery. Obes Surg 13: 921–925PubMedCrossRef

Ammori BJ, Vezakis A, Davides D, Martin IG, Larvin M, McMohon MJ (2001) Laparoscopic cholecystectomy in morbid obese patients. Surg Endosc 15: 1336–1339PubMedCrossRef

National Institutes of Health Consensus Development Draft Conference Statement (1985) Health implications of obesity. Ann Intern Med 103: 1073–1077

Dindo D, Muller MK, Weber M, Clavien PA (2003) Obesity in general elective surgery. Lancet 361: 2032–2035PubMedCrossRef

Bouchard C, Despres JP, Mauriege P (1993) Genetic and nongenetic determinants of regional fat distribution. Endocr Rev 14: 72–93PubMedCrossRef

10.

Bellisari A, Roche AF, Siervogel RM (1993) Reliability of B-mode ultrasonic measurements of subcutaneous adipose tissue and intraabdominal depth: comparisons with skinfold thicknesses. Int J Obes Metab Disord 17: 475–480

11.

Suzuki R, Watanabe S, Hirai Y, Akiyama K, Nishide T, Matsushima Y, Ohshima H, Shinomiya M, Shirai K (1993) Abdominal wall fat index, estimated by ultrasonography, for assessment of the ratio of visceral fat to subcutaneous fat in the abdomen. Am J Med 95: 309–314PubMedCrossRef

12.

Seidell JC, Bakker CJ, van der Kooy K (1990) Imaging techniques for measuring adipose-tissue distribution: a comparison between computed tomography and 1.5-T magnetic resonance. Am J Clin Nutr 51: 953–957PubMed

13.

Ashwell M, Cole TJ, Dixon AK (1985) Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J 290: 1692–1694CrossRef

14.

Kvist H, Chowdhury B, Grangard U, Tylen U, Sjostrom L (1988) Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 48: 1351–1361PubMed

15.

Svendsen OL, Hassager C, Bergmann I, Christiansen C (1993) Measurements of abdominal and intraabdominal fat in postmenopausal women by dual x-ray absorptiometry and anthropometry: comparison with computerized tomography. Int J Obes Relat Metab Disord 17: 45–51PubMed

16.

van der Kooy K, Seidell JC (1993) Techniques for the measurement of visceral fat: a practical guide. Int J Obes Relat Metab Disord 17: 187–196PubMed

17.

Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S (1983) A novel technique for the determination of body fat by computed tomography. Int J Obes 7: 437–445PubMed

18.

Kvist H, Chowdhury B, Sjostrom L, Tylen U, Cederblad A. (1988) Adipose tissue volume determination in males by computed tomography and 40K. Int J Obes 12: 249–266PubMed

19.

Yoshizumi T, Nakamura T, Yamane M, Islam AH, Menju M, Yamasaki K, Arai T, Kotani K, Funahashi T, Yamashita S, Matsuzawa Y (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211: 283–286PubMed

20.

Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery: do we get faster? Surg Endosc 11: 331–335PubMedCrossRef

21.

Yamashita S, Nakamura T, Shimomura I, Nishida M, Yoshida S, Kotani K, Kameda-Takemuara K, Tokunaga K, Matsuzawa Y, (1996) Insulin resistance and body fat distribution. Diabetes Care 19: 1033–1034CrossRef

22.

Matsuzawa Y, Shimomura I, Nakamura T, Keno Y, Tokunaga K (1995) Pathophysiology and pathogenesis of fat obesity. Ann N Y Acad Sci 748: 399–406PubMedCrossRef

23.

Shimomura I, Funahashi T, Takahashi M, Maeda K, Kotani K,Nakamura T, Yamashita S, Miura M, Fukuda Y, Takemura K, Tokunaga K, Matsuzawa Y, (1996) Enhanced expression of PAI-1 in visceral fat: possible contributor to vascular disease in obesity. Nat Med 2: 800–803PubMedCrossRef

24.

Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M (2005) Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg 92: 1261–1262PubMedCrossRef

25.

Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46: 503–509PubMedCrossRef

26.

Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcome of laparoscopic left colectomy. Ann Surg 241: 69–76PubMed

27.

Lee CL, Wu CH, Chen TK, Lai YC, Yang SS, Huang CS, Chen DF (1993) Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy. J Clin Gastroenterol 16: 113–116PubMedCrossRef

28.

Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, Justin J, Schwartz J, Zaren HA (1994) Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc 8: 871–874PubMedCrossRef

Title: Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index
Authors: Y. Seki
M. Ohue
M. Sekimoto
S. Takiguchi
I. Takemasa
M. Ikeda
H. Yamamoto
M. Monden
Publication date: 01-06-2007
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-006-9084-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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