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01-06-2010 | Colorectal Cancer

Body Mass Index does not Affect Postoperative Morbidity and Oncologic Outcomes of Total Mesorectal Excision for Rectal Adenocarcinoma

Authors: Nikiforos Ballian, MBBS, Brett Yamane, MD, Glen Leverson, PhD, Bruce Harms, MD, Charles P. Heise, MD, Eugene F. Foley, MD, Gregory D. Kennedy, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2010

Abstract

Introduction

Obesity adds to the technical difficulty of colorectal surgery and is a risk factor for postoperative complications. We hypothesized that obese patients have increased morbidity and poor oncologic outcomes after proctectomy for rectal adenocarcinoma.

Methods

Adult patients undergoing total mesorectal excision (TME) for rectal adenocarcinoma at a tertiary referral center were retrospectively identified from a prospectively maintained database. Operative characteristics, postoperative complication rates, and oncologic outcomes were compared in patients with BMI ≥ 30 kg/m² and BMI < 30 kg/m².

Results

Between 1997 and 2009, 254 patients underwent proctectomy for rectal adenocarcinoma, of whom 27% were obese. There were no significant differences in demographics, comorbidities or preoperative oncologic characteristics between obese and nonobese groups. Patients with BMI ≥ 30 kg/m² had longer operative times (p = 0.04) and higher intraoperative blood loss (p < 0.001) but comparable postoperative complication rates (p = 0.80), number of lymph nodes retrieved (p = 0.57), margin-negative resections (p = 0.44), and disease-free survival (p = 0.11). Obese patients had longer overall survival (p = 0.05). Tumor stage was the only variable associated with disease-free (p < 0.001) and overall survival (p < 0.001).

Conclusion

Despite increased technical difficulty of resection, obesity does not increase the risk of postoperative morbidity or adversely affect oncologic outcomes after total mesorectal excision of rectal adenocarcinoma.

Bergström A, Pisani P, Tenet V, Wolk A, Adami HO. Overweight as an avoidable cause of cancer in Europe. Int J Cancer. 2001;91:421–30.CrossRefPubMed

Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.CrossRefPubMed

Sarli L, Rollo A, Cecchini S, Regina G, Sansebastiano G, Marchesi F, et al. Impact of obesity on laparoscopic-assisted left colectomy in different stages of the learning curve. Surg Laparosc Endosc Percutan Tech. 2009;19:114–7.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. 2008;18:66–70.CrossRefPubMed

Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007;50:2223–37.CrossRefPubMed

Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg. 2000;179:275–81.CrossRefPubMed

Asteria CR, Gagliardi G, Pucciarelli S, Romano G, Infantino A, La Torre F, et al. Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery. Tech Coloproctol. 2008;12:103–10.CrossRefPubMed

Moon HG, Ju YT, Jeong CY, Jung EJ, Lee YJ, Hong SC, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 2008;15:1918–22.CrossRefPubMed

Görög D, Nagy P, Peter A, Perner F. Influence of obesity on lymph node recovery from rectal resection specimens. Pathol Oncol Res. 2003;9:180–3.CrossRefPubMed

10.

Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M. Impact of visceral obesity on outcome after laparoscopic surgery for rectal cancer. Br J Surg. 2005;92:1261–2.CrossRefPubMed

11.

Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, McCollum AD, Brady D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol. 2004;22:648–57.CrossRefPubMed

12.

http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed 1 Nov 2009.

13.

http://www.asahq.org/clinical/physicalstatus.htm. Accessed 1 Nov 2009.

14.

Mazeh H, Samet Y, Abu-Wasel B, Beglaibter N, Grinbaum R, Cohen T, et al. Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg. 2009;208:355–61.CrossRefPubMed

15.

http://www.cancerstaging.org/education/smcolorectalstagingschema.ppt#256,1,StagingMoments. Accessed 1 Nov 2009.

16.

http://ssdi.rootsweb.ancestry.com/. Accessed 1 Nov 2009.

17.

Bège T, Lelong B, Francon D, Turrini O, Guiramand J, Delpero JR. Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc. 2009;23:1460–4.CrossRefPubMed

18.

Benoist S, Panis Y, Pannegeon V, Alves A, Valleur P. Predictive factors for perioperative blood transfusions in rectal resection for cancer: a multivariate analysis of a group of 212 patients. Surgery. 2001;129:433–9.PubMed

19.

Veenhof AA, Engel AF, van der Peet DL, Sietses C, Meijerink WJ, de Lange-de Klerk ES, et al. Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study. Int J Colorectal Dis. 2008;23:469–75.CrossRefPubMed

20.

Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E. Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg. 2009;250:54–61.CrossRefPubMed

21.

Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum. 2006;49:1108–15.CrossRefPubMed

22.

Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg. 2007;245:1–7.CrossRefPubMed

23.

Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 2008;51:296–300.CrossRefPubMed

24.

Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum. 2007;50:464–71.CrossRefPubMed

25.

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

Title: Body Mass Index does not Affect Postoperative Morbidity and Oncologic Outcomes of Total Mesorectal Excision for Rectal Adenocarcinoma
Authors: Nikiforos Ballian, MBBS
Brett Yamane, MD
Glen Leverson, PhD
Bruce Harms, MD
Charles P. Heise, MD
Eugene F. Foley, MD
Gregory D. Kennedy, MD, PhD
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-0908-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Body Mass Index does not Affect Postoperative Morbidity and Oncologic Outcomes of Total Mesorectal Excision for Rectal Adenocarcinoma

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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