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Updates in Surgery
Published in: Updates in Surgery 2/2019

Open Access 01-06-2019 | Obesity | Original Article

The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer

Authors: Daniel L. H. Baird, Constantinos Simillis, Gianluca Pellino, Christos Kontovounisios, Shahnawaz Rasheed, Paris P. Tekkis

Published in: Updates in Surgery | Issue 2/2019

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Abstract

The objective is to investigate preoperative body mass index (BMI) in patients receiving beyond total mesorectal excision (bTME) surgery. The primary end point is length of postoperative stay. Secondary end points are length of intensive care stay, postoperative morbidity and overall survival. BMI is the most commonly used anthropometric measurement of nutrition and studies have shown that overweight and obese patients can have improved surgical outcomes. Patients who underwent a bTME operation for locally advanced or recurrent rectal cancer were put into three BMI (kg/m2) groups of normal weight (18.5–24.9), overweight (25–29.9) and obese (≥ 30) for analysis. Included are 220 consecutive patients from a single centre. The overall length of stay, in days ± standard deviation (range), for normal weight, overweight and obese patients was 21.14 ± 16.4 (6–99), 15.24 ± 4.3 (7–32) and 19.10 ± 9.8 (8–62) respectively (p = 0.002). The mean ICU length of stay was 5.40 ± 9.1 (1–69), 3.37 ± 2.4 (0–19) and 3.60 ± 2.4 (1–14), respectively (p = 0.030). There was no significant difference between the three groups in terms of postoperative morbidity or overall survival. Patients with a normal weight BMI in this cohort have a significantly longer length of stay in ICU and in hospital than overweight or obese patients. This is seen with no significant difference in morbidity or overall survival.
Literature
1.
Hong YS, Nam BH, Kim KP, Kim JE, Park SJ, Park YS et al (2014) Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 15(11):1245–1253CrossRefPubMed
2.
3.
Mohan HM, Evans MD, Larkin JO, Beynon J, Winter DC (2013) Multivisceral resection in colorectal cancer: a systematic review. Ann Surg Oncol 20(9):2929–2936CrossRefPubMed
4.
Beyond TMEC (2013) Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100(8):E1–E33CrossRef
5.
Faerden AE, Naimy N, Wiik P, Reiertsen O, Weyessa S, Tronnes S et al (2005) Total mesorectal excision for rectal cancer: difference in outcome for low and high rectal cancer. Dis Colon Rectum. 48(12):2224–2231CrossRefPubMed
6.
Wanebo HJ, Antoniuk P, Koness RJ, Levy A, Vezeridis M, Cohen SI et al (1999) Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum. 42(11):1438–1448CrossRefPubMed
7.
Ferenschild FT, Vermaas M, Verhoef C, Ansink AC, Kirkels WJ, Eggermont AM et al (2009) Total pelvic exenteration for primary and recurrent malignancies. World J Surg. 33(7):1502–1508CrossRefPubMedPubMedCentral
8.
Simillis C, Baird DL, Kontovounisios C, Pawa N, Brown G, Rasheed S et al (2017) A systematic review to assess resection margin status after abdominoperineal excision and pelvic exenteration for rectal cancer. Ann Surg 265(2):291–299CrossRefPubMed
9.
10.
Kodeda K, Johansson R, Zar N, Birgisson H, Dahlberg M, Skullman S et al (2015) Time trends, improvements and national auditing of rectal cancer management over an 18-year period. Colorectal Dis 17(9):O168–O179CrossRefPubMed
11.
Salerno GV, Daniels IR, Moran BJ, Heald RJ, Thomas K, Brown G (2009) Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer. Dis Colon Rectum 52(4):632–639CrossRefPubMed
12.
van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefPubMed
13.
Tarraga Lopez PJ, Albero JS, Rodriguez-Montes JA (2014) Primary and secondary prevention of colorectal cancer. Clin Med Insights Gastroenterol 7:33–46PubMedPubMedCentral
14.
Hiram S (1936) Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 6(106):458–460
15.
Mueller C, Compher C, Ellen DM, American Society for Parenteral and Enteral Nutrition Board of Directors (2011) A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. JPEN J Parenter Enteral Nutr 35(1):16–24CrossRefPubMed
16.
Compher C, Higashiguchi T, Yu J, Jensen GL (2017) Does low body mass index predict the hospital mortality of adult Western or Asian patients? JPEN J Parenter Enteral Nutr. 2017:148607117713182
17.
Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA (2006) Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol 59(7):704–709CrossRefPubMed
18.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.
19.
World Health Organisation (1995) Physical status: the use and interpretation of anthropometry Report of a WHO Expert Committee. World Health Organisiation, Geneva
20.
Jensen GL (2016) Global leadership conversation: addressing malnutrition. JPEN J Parenter Enteral Nutr 40(4):455–457CrossRefPubMed
21.
Flegal KM, Kit BK, Graubard BI (2014) Body mass index categories in observational studies of weight and risk of death. Am J Epidemiol 180(3):288–296CrossRefPubMed
22.
23.
Gupta D, Lis CG (2010) Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 9:69CrossRefPubMedPubMedCentral
24.
Gupta D, Vashi PG, Lammersfeld CA, Braun DP (2011) Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab 59(2–4):96–106CrossRefPubMed
25.
Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S (2015) Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr J 14:91CrossRefPubMedPubMedCentral
26.
Yamano T, Yoshimura M, Kobayashi M, Beppu N, Hamanaka M, Babaya A et al (2016) Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage. Int J Colorectal Dis 31(4):877–884CrossRefPubMedPubMedCentral
27.
Lopes JP, de Castro Cardoso Pereira PM, dos Reis Baltazar Vicente AF, Bernardo A, de Mesquita MF (2013) Nutritional status assessment in colorectal cancer patients. Nutr Hosp 28(2):412–418PubMed
28.
Fettes SB, Davidson HI, Richardson RA, Pennington CR (2002) Nutritional status of elective gastrointestinal surgery patients pre- and post-operatively. Clin Nutr. 21(3):249–254CrossRefPubMed
29.
Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol. 34(3):137–168CrossRefPubMed
30.
Karthaus M, Frieler F (2004) Eating and drinking at the end of life. Nutritional support for cancer patients in palliative care. Wien Med Wochenschr 154(9–10):192–198CrossRefPubMed
31.
Garth AK, Newsome CM, Simmance N, Crowe TC (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 23(4):393–401CrossRefPubMed
32.
Burden ST, Hill J, Shaffer JL, Todd C (2010) Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet 23(4):402–407CrossRefPubMed
33.
Waitzberg DL, Correia MI (2003) Nutritional assessment in the hospitalized patient. Curr Opin Clin Nutr Metab Care 6(5):531–538CrossRefPubMed
34.
Doleman B, Mills KT, Lim S, Zelhart MD, Gagliardi G (2016) Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis. Tech Coloproctol 20(8):517–535CrossRefPubMed
35.
36.
37.
Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y, Hollenbeck A et al (2011) Waist circumference as compared with body-mass index in predicting mortality from specific causes. PLoS One 6(4):e18582CrossRefPubMedPubMedCentral
38.
Larsson SC, Rutegard J, Bergkvist L, Wolk A (2006) Physical activity, obesity, and risk of colon and rectal cancer in a cohort of Swedish men. Eur J Cancer 42(15):2590–2597CrossRefPubMed
39.
Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R et al (2006) Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355(8):763–778CrossRefPubMed
40.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348(17):1625–1638CrossRefPubMed
41.
42.
Vigneri PG, Tirro E, Pennisi MS, Massimino M, Stella S, Romano C et al (2015) The insulin/IGF system in colorectal cancer development and resistance to therapy. Front Oncol. 5:230CrossRefPubMedPubMedCentral
43.
Shaukat A, Dostal A, Menk J, Church TR (2017) BMI is a risk factor for colorectal cancer mortality. Dig Dis Sci 62:2511–2517CrossRefPubMed
44.
45.
Kim SE, Shim KN, Jung SA, Yoo K, Moon IH (2007) An association between obesity and the prevalence of colonic adenoma according to age and gender. J Gastroenterol 42(8):616–623CrossRefPubMed
46.
Pischon T, Lahmann PH, Boeing H, Friedenreich C, Norat T, Tjonneland A et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98(13):920–931CrossRefPubMed
47.
Flegal KE, Lustig C (2016) You can go your own way: effectiveness of participant-driven versus experimenter-driven processing strategies in memory training and transfer. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 23(4):389–417CrossRefPubMed
48.
Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250(1):166–172CrossRefPubMed
49.
Fonarow GC (2007) The relationship between body mass index and mortality in patients hospitalized with acute decompensated heart failure. Am Heart J 154(5):e21CrossRefPubMed
50.
Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M, Committee ASA et al (2007) An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 153(1):74–81CrossRefPubMed
51.
Gruberg L, Weissman NJ, Waksman R, Fuchs S, Deible R, Pinnow EE et al (2002) The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol 39(4):578–584CrossRefPubMed
52.
Beaton J, Carey S, Solomon MJ, Tan KK, Young J (2014) Preoperative body mass index, 30-day postoperative morbidity, length of stay and quality of life in patients undergoing pelvic exenteration surgery for recurrent and locally-advanced rectal cancer. Ann Coloproctol 30(2):83–87CrossRefPubMedPubMedCentral
53.
Healy LA, Ryan AM, Sutton E, Younger K, Mehigan B, Stephens R et al (2010) Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis 25(11):1293–1299CrossRefPubMed
54.
O'Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S (2006) Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 34(3):738–744CrossRefPubMedPubMedCentral
55.
Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK (1999) Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int 55(4):1560–1567CrossRefPubMed
56.
Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F et al (2005) The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med 165(1):55–61CrossRefPubMed
57.
Read JA, Choy ST, Beale PJ, Clarke SJ (2006) Evaluation of nutritional and inflammatory status of advanced colorectal cancer patients and its correlation with survival. Nutr Cancer 55(1):78–85CrossRefPubMed
58.
Moghadamyeghaneh Z, Hwang GS, Hanna MH, Carmichael JC, Mills S, Pigazzi A et al (2015) Surgical site infection impact of pelvic exenteration procedure. J Surg Oncol 112(5):533–537CrossRefPubMed
59.
Jimenez RE, Shoup M, Cohen AM, Paty PB, Guillem J, Wong WD (2003) Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer. Dis Colon Rectum 46(12):1619–1625CrossRefPubMed
60.
Speicher PJ, Turley RS, Sloane JL, Mantyh CR, Migaly J (2014) Pelvic exenteration for the treatment of locally advanced colorectal and bladder malignancies in the modern era. J Gastrointest Surg 18(4):782–788CrossRefPubMed
61.
Lee DJ, Sagar PM, Sadadcharam G, Tan KY (2017) Advances in surgical management for locally recurrent rectal cancer: how far have we come? World J Gastroenterol 23(23):4170–4180CrossRefPubMedPubMedCentral
Metadata
Title
The obesity paradox in beyond total mesorectal excision surgery for locally advanced and recurrent rectal cancer
Authors
Daniel L. H. Baird
Constantinos Simillis
Gianluca Pellino
Christos Kontovounisios
Shahnawaz Rasheed
Paris P. Tekkis
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 2/2019
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-019-00631-6

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