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Published in: Surgery Today 5/2017

01-05-2017 | Original Article

Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study

Authors: Hiroyuki Matsuzaki, Soichiro Ishihara, Kazushige Kawai, Koji Murono, Kensuke Otani, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Hiroaki Nozawa, Hironori Yamaguchi, Toshiaki Watanabe

Published in: Surgery Today | Issue 5/2017

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Abstract

Purpose

To evaluate the advantages of laparoscopic surgery for rectal cancer in obese patients.

Methods

We collected clinical data from consecutive patients who underwent anterior resection for rectal cancer between 2008 and 2015 to compare the surgical outcomes of a laparoscopic surgery group (LG) with those of an open surgery group (OG) stratified by obesity. Obesity was defined as a body mass index ≥25.

Results

A total of 268 patients were analyzed, with 157 in the LG (44 obese and 113 non-obese) and 111 in the OG (25 obese and 86 non-obese). The rates of complications between the LG and the OG were 18.5 vs. 11.6 % (p = 0.18) for the non-obese patients and 18.2 vs. 20.0 % (p = 1.0) for the obese patients, respectively, without a significant difference. Operative time was longer in the LG than in the OG, but the difference between the non-obese and obese patients was not significant, being 266 vs. 189 min (p < 0.0001) and 260 vs. 254 min (p = 0.96), respectively. Blood loss was much lower in the LG for both obese and non-obese patients, being 10 vs. 435 mL (p < 0.0001) and 10 vs. 275 mL (p < 0.0001), respectively.

Conclusion

There were no significant differences between LG and OG in operative time or complications for obese patients with rectal cancer, and blood loss was much lower in the LG. Thus, laparoscopic surgery is a safe and minimally invasive approach for obese patients with rectal cancer.
Literature
1.
go back to reference Aytac E, Lavery IC, Kalady MF, Kiran RP. Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum. 2013;56(6):689–97.CrossRefPubMed Aytac E, Lavery IC, Kalady MF, Kiran RP. Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum. 2013;56(6):689–97.CrossRefPubMed
3.
go back to reference Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW, Fazio CVW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003;7(4):558–61.CrossRefPubMed Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW, Fazio CVW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003;7(4):558–61.CrossRefPubMed
4.
go back to reference Vargas GM, Sieloff EP, Parmar AD, Tamirisa NP, Mehta HB, Riall TS. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery. US: Surg Endosc Springer; 2015. Vargas GM, Sieloff EP, Parmar AD, Tamirisa NP, Mehta HB, Riall TS. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery. US: Surg Endosc Springer; 2015.
5.
go back to reference Greenblatt DY, Rajamanickam V, Pugely AJ, Heise CP, Foley EF, Kennedy GD. Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg. 2011;212(5):844–54.CrossRefPubMedPubMedCentral Greenblatt DY, Rajamanickam V, Pugely AJ, Heise CP, Foley EF, Kennedy GD. Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg. 2011;212(5):844–54.CrossRefPubMedPubMedCentral
6.
go back to reference Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014;16(5):382–9.CrossRefPubMed Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014;16(5):382–9.CrossRefPubMed
7.
go back to reference Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
8.
go back to reference Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today Springer Jpn. 2016;46(6):668–85.CrossRef Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today Springer Jpn. 2016;46(6):668–85.CrossRef
9.
go back to reference Yuji M, Tadashi N, Masahiko T, Miwa R. New criteria for “obesity disease” in Japan. Circ J. 2002;66(11):987–92.CrossRef Yuji M, Tadashi N, Masahiko T, Miwa R. New criteria for “obesity disease” in Japan. Circ J. 2002;66(11):987–92.CrossRef
10.
go back to reference Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20(2):207–39.CrossRefPubMedPubMedCentral Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20(2):207–39.CrossRefPubMedPubMedCentral
11.
go back to reference Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T. Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc Other Interv Tech. 2008;22(2):557–61.CrossRef Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T. Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc Other Interv Tech. 2008;22(2):557–61.CrossRef
12.
go back to reference Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132 (quiz 133–4; discussion 96).CrossRefPubMed Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132 (quiz 133–4; discussion 96).CrossRefPubMed
13.
go back to reference Miyamoto Y, Ishii T, Tashiro J, Satoh T, Watanabe M, Baba H, et al. Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surg Today. 2014;44(7):1293–9.CrossRefPubMed Miyamoto Y, Ishii T, Tashiro J, Satoh T, Watanabe M, Baba H, et al. Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surg Today. 2014;44(7):1293–9.CrossRefPubMed
14.
go back to reference Cai Y, Zhou Y, Li Z, Xiang J, Chen Z. Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: a comparative study with open colectomy. Oncol Lett. 2013;6(4):1057–62.PubMedPubMedCentral Cai Y, Zhou Y, Li Z, Xiang J, Chen Z. Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: a comparative study with open colectomy. Oncol Lett. 2013;6(4):1057–62.PubMedPubMedCentral
15.
go back to reference Oyasiji T, Baldwin K, Katz SC, Espat NJ, Somasundar P. Feasibility of purely laparoscopic resection of locally advanced rectal cancer in obese patients. World J Surg Oncol. 2012;10:147.CrossRefPubMedPubMedCentral Oyasiji T, Baldwin K, Katz SC, Espat NJ, Somasundar P. Feasibility of purely laparoscopic resection of locally advanced rectal cancer in obese patients. World J Surg Oncol. 2012;10:147.CrossRefPubMedPubMedCentral
16.
go back to reference Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Kirbiyik E. Impact of increased body mass index on laparoscopic surgery for rectal cancer. Eur Surg Res Eur Chir Forschung Rech Chir Eur. 2011;46(2):87–93. Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E, Kirbiyik E. Impact of increased body mass index on laparoscopic surgery for rectal cancer. Eur Surg Res Eur Chir Forschung Rech Chir Eur. 2011;46(2):87–93.
17.
go back to reference Makino T, Trencheva K, Shukla PJ, Rubino F, Zhuo C, Pavoor RS, et al. The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery. 2014;156:661–8.CrossRefPubMed Makino T, Trencheva K, Shukla PJ, Rubino F, Zhuo C, Pavoor RS, et al. The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery. 2014;156:661–8.CrossRefPubMed
18.
go back to reference Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E. Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis. 2013;15(4):463–9.CrossRefPubMed Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E. Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis. 2013;15(4):463–9.CrossRefPubMed
19.
go back to reference Poulsen M, Ovesen H. 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. 2012;16(8):1554–8.CrossRefPubMed Poulsen M, Ovesen H. 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. 2012;16(8):1554–8.CrossRefPubMed
20.
go back to reference Singh A, Muthukumarasamy G, Pawa N, Riaz AA, Hendricks JB, Motson RW. Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis. 2011;13(8):878–83.CrossRefPubMed Singh A, Muthukumarasamy G, Pawa N, Riaz AA, Hendricks JB, Motson RW. Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis. 2011;13(8):878–83.CrossRefPubMed
21.
go back to reference Park JW, Lim S-W, Choi HS, Jeong S-Y, Oh JH, Lim S-B. The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc. 2010;24(7):1679–85.CrossRefPubMed Park JW, Lim S-W, Choi HS, Jeong S-Y, Oh JH, Lim S-B. The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc. 2010;24(7):1679–85.CrossRefPubMed
22.
go back to reference Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero J-R. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23(7):1460–4.CrossRefPubMed Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero J-R. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23(7):1460–4.CrossRefPubMed
23.
go back to reference Scheidbach H, Benedix F, Hügel O, Kose D, Köckerling F, Lippert H. Laparoscopic approach to colorectal procedures in the obese patient: risk factor or benefit? Obes Surg. 2007;18(1):66–70.CrossRefPubMed Scheidbach H, Benedix F, Hügel O, Kose D, Köckerling F, Lippert H. Laparoscopic approach to colorectal procedures in the obese patient: risk factor or benefit? Obes Surg. 2007;18(1):66–70.CrossRefPubMed
24.
go back to reference Kang J, Baek S-E, Kim T, Hur H, Min BS, Lim JS, et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Colorectal Dis. 2012;27(4):497–505.CrossRefPubMed Kang J, Baek S-E, Kim T, Hur H, Min BS, Lim JS, et al. Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index. Int J Colorectal Dis. 2012;27(4):497–505.CrossRefPubMed
25.
go back to reference Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M, et al. Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc. 2007;21(6):929–34.CrossRefPubMed Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M, et al. Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc. 2007;21(6):929–34.CrossRefPubMed
26.
go back to reference Bokey L, Chapuis PH, Dent OF. Impact of obesity on complications after resection for rectal cancer. Colorectal Dis. 2014;16(11):896–906.CrossRefPubMed Bokey L, Chapuis PH, Dent OF. Impact of obesity on complications after resection for rectal cancer. Colorectal Dis. 2014;16(11):896–906.CrossRefPubMed
27.
go back to reference Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis. 2014;29(3):343–51.CrossRefPubMed Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, et al. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis. 2014;29(3):343–51.CrossRefPubMed
28.
go back to reference Esemuede IO, Murray ACA, Lee-Kong SA, Feingold DL, Kiran RP. Obesity, regardless of comorbidity, influences outcomes after colorectal surgery-time to rethink the pay-for-performance metrics? J Gastrointest Surg. 2014;18(12):2163–8.CrossRefPubMed Esemuede IO, Murray ACA, Lee-Kong SA, Feingold DL, Kiran RP. Obesity, regardless of comorbidity, influences outcomes after colorectal surgery-time to rethink the pay-for-performance metrics? J Gastrointest Surg. 2014;18(12):2163–8.CrossRefPubMed
29.
go back to reference Velchuru VR, Domajnko B, deSouza A, Marecik S, Prasad LM, Park JJ, et al. Obesity increases the risk of postoperative peripheral neuropathy after minimally invasive colon and rectal surgery. Dis Colon Rectum. 2014;57(2):187–93.CrossRefPubMed Velchuru VR, Domajnko B, deSouza A, Marecik S, Prasad LM, Park JJ, et al. Obesity increases the risk of postoperative peripheral neuropathy after minimally invasive colon and rectal surgery. Dis Colon Rectum. 2014;57(2):187–93.CrossRefPubMed
30.
go back to reference Makino T, Shukla PJ, Rubino F, Milsom JW. The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg. 2012;255(2):228–36.CrossRefPubMed Makino T, Shukla PJ, Rubino F, Milsom JW. The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg. 2012;255(2):228–36.CrossRefPubMed
31.
go back to reference Zhou Y, Wu L, Li X, Wu X, Li B. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26(3):783–9.CrossRefPubMed Zhou Y, Wu L, Li X, Wu X, Li B. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26(3):783–9.CrossRefPubMed
32.
go back to reference Park J, Choi G-S, Kim S, Kim H, Kim N, Lee K, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean Laparoscopic Colorectal Surgery Study Group. Ann Surg. 2013;257(4):665–71.CrossRefPubMed Park J, Choi G-S, Kim S, Kim H, Kim N, Lee K, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean Laparoscopic Colorectal Surgery Study Group. Ann Surg. 2013;257(4):665–71.CrossRefPubMed
33.
go back to reference Kim MJ, Shin R, Oh H-K, Park JW, Jeong S-Y, Park J-G. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg. 2011;35(12):2806–10.CrossRefPubMed Kim MJ, Shin R, Oh H-K, Park JW, Jeong S-Y, Park J-G. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg. 2011;35(12):2806–10.CrossRefPubMed
34.
go back to reference Liu Z, Kang L, Huang M, Luo Y, Wang L, Lan P, et al. Open surgery against laparoscopic surgery for mid-rectal or low-rectal cancer of male patients: better postoperative genital function of laparoscopic surgery. Surg Laparosc Endosc Percutan Tech. 2015;25(5):444–8.CrossRefPubMed Liu Z, Kang L, Huang M, Luo Y, Wang L, Lan P, et al. Open surgery against laparoscopic surgery for mid-rectal or low-rectal cancer of male patients: better postoperative genital function of laparoscopic surgery. Surg Laparosc Endosc Percutan Tech. 2015;25(5):444–8.CrossRefPubMed
35.
go back to reference Jung SH, Kim JH. Comparative study of postoperative complications in patients with and without an obstruction who had left-sided colorectal cancer and underwent a single-stage operation after mechanical bowel preparation. Ann Coloproctol. 2014;30(6):251–8.CrossRefPubMedPubMedCentral Jung SH, Kim JH. Comparative study of postoperative complications in patients with and without an obstruction who had left-sided colorectal cancer and underwent a single-stage operation after mechanical bowel preparation. Ann Coloproctol. 2014;30(6):251–8.CrossRefPubMedPubMedCentral
36.
go back to reference Sasaki K, Kazama S, Sunami E, Tsuno NH, Nozawa H, Nagawa H, et al. One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum. 2012;55(1):72–8.CrossRefPubMed Sasaki K, Kazama S, Sunami E, Tsuno NH, Nozawa H, Nagawa H, et al. One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum. 2012;55(1):72–8.CrossRefPubMed
37.
go back to reference Denost Q, Laurent C, Paumet T, Quintane L, Martenot M, Rullier E. Laparoscopic surgery for rectal cancer: preoperative radiochemotherapy versus surgery alone. Surg Endosc. 2012;26(7):1878–83.CrossRefPubMed Denost Q, Laurent C, Paumet T, Quintane L, Martenot M, Rullier E. Laparoscopic surgery for rectal cancer: preoperative radiochemotherapy versus surgery alone. Surg Endosc. 2012;26(7):1878–83.CrossRefPubMed
Metadata
Title
Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study
Authors
Hiroyuki Matsuzaki
Soichiro Ishihara
Kazushige Kawai
Koji Murono
Kensuke Otani
Koji Yasuda
Takeshi Nishikawa
Toshiaki Tanaka
Tomomichi Kiyomatsu
Keisuke Hata
Hiroaki Nozawa
Hironori Yamaguchi
Toshiaki Watanabe
Publication date
01-05-2017
Publisher
Springer Japan
Published in
Surgery Today / Issue 5/2017
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-016-1421-6

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