Top

Published in:

01-05-2017 | Review

Laparoscopic colorectal cancer resections in the obese: a systematic review

Authors: Alastair Fung, Nora Trabulsi, Martin Morris, Richard Garfinkle, Abdulaziz Saleem, Steven D. Wexner, Carol-Ann Vasilevsky, Marylise Boutros

Published in: Surgical Endoscopy | Issue 5/2017

Abstract

Background

Laparoscopic colorectal cancer operations in obese patients pose technical challenges that may negatively impact oncologic adequacy. A meta-analysis was performed to assess the oncologic outcomes of laparoscopic colorectal cancer resections in obese compared to non-obese patients. Short- and long-term outcomes were assessed secondarily.

Methods

A systematic literature search was conducted from inception until October 01, 2014. Studies that compared outcomes of laparoscopic colorectal malignant neoplasms in obese and non-obese patients were selected for meta-analysis. Studies that defined obesity as body mass index (BMI) ≥ 30 kg/m² were included. Oncologic, operative, and postoperative outcomes were evaluated. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95 % confidence intervals (CI) were calculated using fixed-effects models. For oncologic and survival outcomes, a subgroup analysis was conducted for rectal cancer and a secondary analysis was conducted for Asian studies that used a BMI cutoff of 25 kg/m².

Results

Thirteen observational studies with a total of 4550 patients were included in the meta-analysis. Lymph node retrieval, distal, and circumferential margins, and 5-year disease-free and overall survival were similar in the obese and non-obese groups. Conversion rate (OR 2.11, 95 % CI 1.58–2.81), postoperative morbidity (OR 1.54, 95 % CI 1.21–1.97), wound infection (OR 2.43, 95 % CI 1.46–4.03), and anastomotic leak (OR 1.65, 95 % CI 1.01–2.71) were all significantly increased in the obese group.

Conclusions

Laparoscopic colorectal cancer operations in obese patients pose an increased technical challenge as demonstrated by higher conversion rates and higher risk of postoperative complications compared to non-obese patients. Despite these challenges, oncologic adequacy of laparoscopic colorectal cancer resections is comparable in both groups.

Available only for authorised users

Tran BX, Nair AV, Kuhle S, Ohinmaa A, Veugelers PJ (2013) Cost analyses of obesity in Canada: scope, quality, and implications. Cost Effectiveness Resour Alloc C/E 11(1):3CrossRefPubMed

Balentine CJ, Marshall C, Robinson C, Wilks J, Anaya D, Albo D et al (2010) Obese patients benefit from minimally invasive colorectal cancer surgery. J Surg Res 163(1):29–34CrossRefPubMed

Lascano CA, Kaidar-Person O, Szomstein S, Rosenthal R, Wexner SD (2006) Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg 192(3):357–365CrossRefPubMed

Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio CVW (2003) Laparoscopic colectomy in obese and non-obese patients. J Gastrointest Surg. 7(4):558–561CrossRefPubMed

Bege T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero JR (2009) Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 23(7):1460–1464CrossRefPubMed

Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255(2):228–236CrossRefPubMed

Zhou Y, Wu L, Li X, Wu X, Li B (2012) Outcome of laparoscopic colorectal surgery in obese and non-obese patients: a meta-analysis. Surg Endosc 26(3):783–789CrossRefPubMed

Obesity (2000) preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 894(i–xii):1–253

Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC et al (2009) Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 12(4):497–506CrossRefPubMed

10.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMed

11.

Higgins J, Green S (editors). Cochrane handbook for systematic reviews of interventions, Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. www.cochrane-handbook.org

12.

Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T et al (2011) Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech. 21(6):409–414CrossRefPubMed

13.

Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E (2013) Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis 15(4):463–469CrossRefPubMed

14.

Kamoun S, Alves A, Bretagnol F (2010) Outcomes of laparoscopic colorectal surgery in obese and non-obese patients: a case-matched study of 180 patients. Dis Colon Rectum 53(4):511–512

15.

Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Kirbiyik E (2011) Impact of increased body mass index on laparoscopic surgery for rectal cancer. Eur Surg Res 46(2):87–93CrossRefPubMed

16.

Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241(1):69–76PubMedPubMedCentral

17.

Liang J, Wang Z, Zhou Z, Hu J, Zhao P (2012) Impact of obesity on laparoscopic surgery for rectal cancer. Cancer Res Prev Treat 39(8):914–917

18.

Makino T, Trencheva K, Shukla PJ, Rubino F, Zhuo C, Pavoor RS et al (2014) The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery 156(3):661–668CrossRefPubMed

19.

Oyasiji T, Baldwin K, Katz SC, Espat NJ, Somasundar P (2012) Feasibility of purely laparoscopic resection of locally advanced rectal cancer in obese patients. World J Surg Oncol 10:147CrossRefPubMedPubMedCentral

20.

Park JW, Lim SW, Choi HS, Jeong SY, Oh JH, Lim SB (2010) The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc 24(7):1679–1685CrossRefPubMed

21.

Poulsen M, Ovesen H (2012) Is laparoscopic colorectal cancer surgery in obese patients associated with an increased risk? Short-term results from a single center study of 425 patients. J Gastrointest Surg 16(8):1554–1558CrossRefPubMed

22.

Singh A, Muthukumarasamy G, Pawa N, Riaz AA, Hendricks JB, Motson RW (2011) Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis 13(8):878–883CrossRefPubMed

23.

Xia X, Huang C, Jiang T, Cen G, Cao J, Huang KJ et al (2014) Is laparoscopic colorectal cancer surgery associated with an increased risk in obese patients? A retrospective study from China. World J Surg Oncol 12:7CrossRef

24.

Akagi T, Inomata M, Etoh T, Moriyama H, Yasuda K, Shiraishi N et al (2012) Multivariate evaluation of the technical difficulties in performing laparoscopic anterior resection for rectal cancer. Surg Laparosc Endosc Percutan Tech 22(1):52–57CrossRefPubMed

25.

Akiyoshi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Konishi T et al (2010) Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc 24(11):2749–2754CrossRefPubMed

26.

Hotta T, Takifuji K, Yokoyama S, Matsuda K, Oku Y, Nasu T et al (2012) The impact of obesity on learning laparoscopic surgery for colon cancer. J Laparoendosc Adv Surg Tech A 22(7):635–640CrossRefPubMed

27.

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(10):1261–1262CrossRefPubMed

28.

Kang J, Baek SE, Kim T, Hur H, Min BS, Lim JS et al (2012) Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Colorectal Dis 27(4):497–505CrossRefPubMed

29.

Lim SW, Huh JW, Kim YJ, Kim HR (2013) Vertical transumbilical incision versus left lower transverse incision for specimen retrieval during laparoscopic colorectal surgery. Tech Coloproctol 17(1):59–65CrossRefPubMed

30.

Miyamoto Y, Ishii T, Tashiro J, Satoh T, Watanabe M, Baba H et al (2014) Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surgery 44(7):1293–1299

31.

Nakamura T, Miura H, Ikeda A, Sato T, Naito M, Ogura N et al (2013) Laparoscopic surgery for colon cancer in obese patients: a case-matched control study. Surgery 43(7):763–768

32.

Nitori N, Hasegawa H, Ishii Y, Endo T, Kitagawa Y (2009) Impact of visceral obesity on short-term outcome after laparoscopic surgery for colorectal cancer: a single Japanese center study. Surg Laparosc Endosc Percutan Tech 19(4):324–327CrossRefPubMed

33.

Sakamoto K, Niwa S, Tanaka M, Goto M, Sengoku H, Tomiki Y (2007) Influence of obesity on the short-term outcome of laparoscopic colectomy for colorectal cancer. J Minim Access Surg 3(3):98–103CrossRefPubMedPubMedCentral

34.

Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O et al (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51(12):1757–1765 Discussion 65-7 CrossRefPubMed

35.

Woo JH, Park KJ, Choi HJ (2009) The impacts of obesity on a laparoscopic low anterior resection [Korean]. J Korean Soc Coloproctol 25(5):306–311CrossRef

36.

Blumberg D (2009) Laparoscopic colectomy performed using a completely intracorporeal technique is associated with similar outcome in obese and thin patients. Surg Laparosc Endosc Percutan Tech 19(1):57–61CrossRefPubMed

37.

Offodile AC 2nd, Lee SW, Yoo J, Whelan RL, Moradi D, Baxter R et al (2008) Does prior abdominal surgery influence conversion rates and outcomes of laparoscopic right colectomy in patients with neoplasia? Dis Colon Rectum 51(11):1669–1674CrossRefPubMed

38.

Linebarger JH, Mathiason MA, Kallies KJ, Shapiro SB (2010) Does obesity impact lymph node retrieval in colon cancer surgery? Am J Surg 200(4):478–482CrossRefPubMed

39.

Schwandner O, Schiedeck TH, Bruch H (1999) The role of conversion in laparoscopic colorectal surgery: Do predictive factors exist? Surg Endosc 13(2):151–156CrossRefPubMed

40.

Geiger TM, Muldoon R (2011) Complications following colon rectal surgery in the obese patient. Clin colon Rectal Surg 24(4):274–282CrossRefPubMedPubMedCentral

41.

Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50(12):2223–2237CrossRefPubMed

42.

Esemuede IO, Murray AC, Lee-Kong SA, Feingold DL, Kiran RP (2014) Obesity, regardless of comorbidity, influences outcomes after colorectal surgery-time to rethink the pay-for-performance metrics? J Gastrointest Surg 18(12):2163–2168CrossRefPubMed

43.

Frasson M, Granero-Castro P, Ramos Rodriguez JL, Flor-Lorente B, Braithwaite M, Marti Martinez E et al (2015) Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. Int J Colorectal Dis 31(1):105–114CrossRefPubMed

44.

Li Destri G, Di Carlo I, Scilletta R, Scilletta B, Puleo S (2014) Colorectal cancer and lymph nodes: the obsession with the number 12. World J Gastroenterol 20(8):1951–1960CrossRefPubMedPubMedCentral

45.

Hellan M, Ouellette J, Lagares-Garcia JA, Rauh SM, Kennedy HL, Nicholson JD et al (2015) Robotic rectal cancer resection: a retrospective multicenter analysis. Ann Surg Oncol 22(7):2151–2158CrossRefPubMed

46.

Pigazzi (2015) A Robotic versus laparoscopic resection for rectal cancer an international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus laparoscopic surgery for treatment of rectal cancer. ASCRS annual meeting, Boston

47.

Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Diaz del Gobbo G et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261(2):221–227CrossRefPubMed

48.

Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B et al (2015) Transanal Total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221(2):415–423CrossRefPubMed

49.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210CrossRefPubMed

50.

Tuech JJ, Karoui M, Lelong B, De Chaisemartin C, Bridoux V, Manceau G et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261(2):228–233CrossRefPubMed

51.

Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C et al (2015) COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc 30(8):3210–3215CrossRefPubMedPubMedCentral

52.

Sohn DK A pilot study for the evaluation of the safety and the efficacy of transanal total mesorectal excision in difficult cases of laparoscopic surgery for rectal cancer. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2016 Jul 17]. https://clinicaltrials.gov/show/NCT02421432 NLM Identifier: NCT02421432

53.

Bonjer HJ, Haglind E, Jeekel I, Kazemier G, Pahlman L, Hop WCJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefPubMed

54.

Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332CrossRefPubMed

55.

Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M et al (2015) Effect of laparoscopic-assisted resection versus open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355CrossRefPubMedPubMedCentral

56.

Gillies D, Sampson S, Beck A, Rathbone J (2013) Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev 4:CD003079

Title: Laparoscopic colorectal cancer resections in the obese: a systematic review
Authors: Alastair Fung
Nora Trabulsi
Martin Morris
Richard Garfinkle
Abdulaziz Saleem
Steven D. Wexner
Carol-Ann Vasilevsky
Marylise Boutros
Publication date: 01-05-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5209-y

At a glance: The STEP trials

Springer Medicine

Laparoscopic colorectal cancer resections in the obese: a systematic review

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2017

Impact of miniport laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy on recovery of physical activity: a randomized trial

Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database

LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure

The effect of a performance-based intra-procedural checklist on a simulated emergency laparoscopic task in novice surgeons

Factors predicting outcome from enhanced recovery programmes in laparoscopic colorectal surgery: a systematic review

Phosphate tablets or polyethylene glycol for preparation to colonoscopy? A multicentre non-inferiority randomized controlled trial