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Zhao H, Liu G, Li Y, Lu F, Yang N, Zhao J. Body fat ratio as a novel predictor of complications and survival after rectal cancer surgery. Front Nutr 2024; 11:1398807. [PMID: 39183988 PMCID: PMC11341451 DOI: 10.3389/fnut.2024.1398807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024] Open
Abstract
Background The present study aimed to evaluate the association between body fat ratio (BFR), visceral fat area (VFA), body mass index (BMI) and visceral fat density (VFD) and assess their reliability in assessing risk of postoperative complications and survival status in patients with rectal cancer (RC). Materials and methods The present study retrospectively included 460 patients who underwent surgical treatment for RC at the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College, Wuhu, China) between September 2018 and July 2021. BFR, VFA, BMI, and VFD were measured and basic information, clinical data, complications and survival were recorded. Results Statistical analysis was performed to determine optimal BFR cut-off and evaluate group differences. BFR demonstrated a significant positive correlation with VFA (R = 0.739) and BMI (R = 0.783) and significant negative correlation with VFD (R = -0.773). The areas under the receiver operating characteristic curve of BFR, VFA, BMI, and VFD in predicting postoperative complications in RC were all >0.7 and the optimal cut-off value of BFR was 24.3. Patients in the BFR-low group had fewer postoperative complications, lower intraoperative indices, shorter hospitalization times and lower costs than those in the BFR-high group. BFR predicted complications with high diagnostic significance and was validated by multiple models. Furthermore, patients in the BFR-high group had a longer overall survival compared with patients in the BFR-low group. Conclusion BFR was associated with BMI, VFA, and VFD. A BFR threshold of 24.3 was correlated with decreased complications and enhanced long-term survival.
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Affiliation(s)
| | | | | | | | | | - Jun Zhao
- Department of General Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
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Li X, Zhou Z, Zhu B, Wu Y, Xing C. Development and validation of machine learning models and nomograms for predicting the surgical difficulty of laparoscopic resection in rectal cancer. World J Surg Oncol 2024; 22:111. [PMID: 38664824 PMCID: PMC11044303 DOI: 10.1186/s12957-024-03389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The objective of this study is to develop and validate a machine learning (ML) prediction model for the assessment of laparoscopic total mesorectal excision (LaTME) surgery difficulty, as well as to identify independent risk factors that influence surgical difficulty. Establishing a nomogram aims to assist clinical practitioners in formulating more effective surgical plans before the procedure. METHODS This study included 186 patients with rectal cancer who underwent LaTME from January 2018 to December 2020. They were divided into a training cohort (n = 131) versus a validation cohort (n = 55). The difficulty of LaTME was defined based on Escal's et al. scoring criteria with modifications. We utilized Lasso regression to screen the preoperative clinical characteristic variables and intraoperative information most relevant to surgical difficulty for the development and validation of four ML models: logistic regression (LR), support vector machine (SVM), random forest (RF), and decision tree (DT). The performance of the model was assessed based on the area under the receiver operating characteristic curve(AUC), sensitivity, specificity, and accuracy. Logistic regression-based column-line plots were created to visualize the predictive model. Consistency statistics (C-statistic) and calibration curves were used to discriminate and calibrate the nomogram, respectively. RESULTS In the validation cohort, all four ML models demonstrate good performance: SVM AUC = 0.987, RF AUC = 0.953, LR AUC = 0.950, and DT AUC = 0.904. To enhance visual evaluation, a logistic regression-based nomogram has been established. Predictive factors included in the nomogram are body mass index (BMI), distance between the tumor to the dentate line ≤ 10 cm, radiodensity of visceral adipose tissue (VAT), area of subcutaneous adipose tissue (SAT), tumor diameter >3 cm, and comorbid hypertension. CONCLUSION In this study, four ML models based on intraoperative and preoperative risk factors and a nomogram based on logistic regression may be of help to surgeons in evaluating the surgical difficulty before operation and adopting appropriate responses and surgical protocols.
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Affiliation(s)
- Xiangyong Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Zeyang Zhou
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Bing Zhu
- Department of Anesthesiology, Dongtai People's Hospital, Yancheng, Jiangsu Province, China
| | - Yong Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China.
| | - Chungen Xing
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China.
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Yu L, Wu W, Xia S, Li Y, Xu Z. Visceral obesity and anastomotic leakage rates in colorectal cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1224196. [PMID: 37671054 PMCID: PMC10476096 DOI: 10.3389/fonc.2023.1224196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background Numberous studies have heatedly discussed whether obesity is a risk factor for anastomotic leakage (AL) because of the increasing number of colorectal cancer (CRC) cases and high incidence of CRC in patients with obesity. Objective We aimed to explore the relationship between visceral obesity(VO) and AL after CRC surgery. The databases of Pubmed, Embase, and the Cochrane Library were searched for relevant data and articles published until November 1, 2022. We identified the difference in the incidence of AL after CRC surgery between patients with and without VO. The quality of included studies was evaluated using the Newcastle- Ottawa Scale, and odds ratio (OR) and 95% CI were used to assess the association between VO and AL. Results This meta-analysis included 7 studies with 2,136 patients. The OR of patients with VO versus those without VO was 2.15 (95%CIs = 1.46-3.15, test for heterogeneity: P = 0.29, I2 = 18%) based on the fixed-effect model in seven studies. Notably, the difference between the two groups was statistically significant (Z = 3.91 P < 0.0001). Patients with VO in the colon cancer group exhibited a higher incidence of AL (OR = 2.88, 95% CIs = 1.38-5.99, test for heterogeneity: P = 0.27, I2 = 20%) than those in the rectal cancer group (OR = 2.74, 95% CIs = 1.13-6.65, test for heterogeneity: P = 0.20, I2 = 38%). In the studies in the relevant literature, heterogeneity was low. Regarding patients with VO, four Asian studies reported increased morbidity due to AL (OR = 2.79, 95% CIs = 1.35-5.78, test for heterogeneity: P = 0.35, I2 = 9%) compared with three non-Asian studies. Conclusions Our findings confirmed the significant relationship between VO and AL. Thus, VO could be considered a reliable risk factor of surgery for colon cancer.
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Affiliation(s)
| | - Wenjiang Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
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Kim HS, Kim KH, Noh GT, Lee RA, Chung SS. Body composition index obtained by using a bioelectrical impedance analysis device can be a predictor of prolonged operative time in patients undergoing minimally invasive colorectal surgery. Ann Coloproctol 2023; 39:342-350. [PMID: 35655396 PMCID: PMC10475805 DOI: 10.3393/ac.2022.00262.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes. METHODS Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed. RESULTS Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064-16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531-0.764; P=0.024). CONCLUSION The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.
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Affiliation(s)
- Ho Seung Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Yuan W, Wang X, Wang Y, Wang H, Yan C, Song G, Liu C, Li A, Yang H, Gao C, Chen J. Development and validation of a nomogram for predicting operating time in laparoscopic anterior resection of rectal cancer. J Cancer Res Ther 2023; 19:964-971. [PMID: 37675724 DOI: 10.4103/jcrt.jcrt_2223_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Aims The goal of this study is to create and verify a nomogram estimate operating time in rectal cancer (RC) patients based on clinicopathological factors and MRI/CT measurements before surgery. Materials and Methods The nomogram was developed in a cohort of patients who underwent laparoscopic anterior resection (L-AR) for RC. The clinicopathological and pelvis parameters were collected. Risk factors for a long operating time were determined by univariate and multivariate logistic regression analyses, and a nomogram was established with independent risk factors. The performance of the nomogram was evaluated. An independent cohort of consecutive patients served as the validation dataset. Results The development group recruited 159 RC patients, while 54 patients were enrolled in the validation group. Independent risk factors identified in multivariate analysis were a distance from the anal verge <5 cm (P = 0.024), the transverse diameter of the pelvic inlet (P < 0.001), mesorectal fat area (P = 0.017), and visceral fat area (P < 0.001). Then, a nomogram was built based on these four independent risk factors. The C-indexes of the nomogram in the development and validation group were 0.886 and 0.855, respectively. And values of AUC were the same with C-indexes in both groups. Besides, the calibration plots showed satisfactory consistency between actual observation and nomogram-predicted probabilities of long operating time. Conclusions A nomogram for predicting the risk of long operating duration in L-AR of RC was developed. And the nomogram displayed a good prediction effect and can be utilized as a tool for evaluating operating time preoperatively.
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Affiliation(s)
- Wenguang Yuan
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiao Wang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yi Wang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Haoran Wang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Weifang Medical University, Weifang, China
| | - Chuanwang Yan
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Weifang Medical University, Weifang, China
| | - Gesheng Song
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chang Liu
- Department of Gastrointestinal Surgery, Feicheng People's Hospital, Tai'an, Shandong, China
| | - Aiyin Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hui Yang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chengsheng Gao
- General Surgery Department of Laiwu People's Hospital of Jinan City, Jinan, China
| | - Jingbo Chen
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
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Correa-Paris A, Gorraiz Ochoa V, Hernandez Gutiérrez A, Gilabert Estellés J, Díaz-Feijoo B, Gil-Moreno A. Simple radiologic assessment of visceral obesity and prediction of surgical morbidity in endometrial cancer patients undergoing laparoscopic aortic lymphadenectomy: A reliability and accuracy study. J Obstet Gynaecol Res 2023; 49:988-997. [PMID: 36593218 DOI: 10.1111/jog.15528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023]
Abstract
AIM To evaluate the reliability of sagittal abdominal diameter (SAD)-a surrogate of visceral obesity-in magnetic resonance imaging, and its accuracy to predict the surgical morbidity of aortic lymphadenectomy. METHODS We conducted a multicenter reliability (phase 1) and accuracy (phase 2) cohort study in three Spanish referral hospitals. We retrospectively analyzed data from the STELLA-2 randomized controlled trial that included high-risk endometrial cancer patients undergoing minimally invasive surgical staging. Patients were classified into subgroups: conventional versus robotic-assisted laparoscopy, and transperitoneal versus extraperitoneal technique. In the first phase, we measured the agreement of three SAD measurements (at the umbilicus, renal vein, and inferior mesenteric artery) and selected the most reliable one. In phase 2, we evaluated the diagnostic accuracy of SAD to predict surgical morbidity. Surgical morbidity was the main outcome measure, it was defined by a core outcome set including variables related to blood loss, operative time, surgical complications, and para-aortic lymphadenectomy difficulty. RESULTS In phase 1, all measurements showed good inter-rater and intra-rater agreement. Umbilical SAD (u-SAD) was the most reliable one. In phase 2, we included 136 patients. u-SAD had a good diagnostic accuracy to predict surgical morbidity in patients undergoing transperitoneal laparoscopic lymphadenectomy (0.73 in ROC curve). It performed better than body mass index and other anthropometric measurements. We calculated a cut-off point of 246 mm (sensitivity: 0.56, specificity: 0.80). CONCLUSIONS u-SAD is a simple, reliable, and potentially useful measurement to predict surgical morbidity in endometrial cancer patients undergoing minimally invasive surgical staging, especially when facing transperitoneal aortic lymphadenectomy.
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Affiliation(s)
- Alejandro Correa-Paris
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Verónica Gorraiz Ochoa
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Gilabert Estellés
- Obstetrics and Gynecology Department, Hospital General de Valencia, Valencia, Spain.,University of Valencia, Valencia, Spain
| | - Berta Díaz-Feijoo
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Research Group in Gynecology, Vall d'Hebron Institut de Recerca, Barcelona, Spain
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Shah J, Yu S, Huang J, Zang L, Li T, Zhu Z. Intra-abdominal fat volume estimation by multi-detector rows computed tomography: relevance in surgical fellowship training program in Shanghai: a retrospective study. PeerJ 2023; 11:e15156. [PMID: 37096062 PMCID: PMC10122455 DOI: 10.7717/peerj.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 04/26/2023] Open
Abstract
Background Intra-abdominal fat volume (IFV) has been shown to have a negative impact on surgical outcomes in gastric cancer (GC) and other gastrointestinal surgeries. The purpose of this study is to look into the relationship between IFV and perioperative outcomes in GC patients using multi-detector rows computed tomography (MDCT) and assess the importance of implementing this observation in current surgical fellowship training programs. Methods Patients with GC who underwent open D2 gastrectomy between May 2015 and September 2017 were included in the study. Based on MDCT estimation, patients were divided into high IFV (IFV ≥ 3,000 ml) and low IFV (IFV < 3,000 ml) groups. Perioperative outcomes for cancer staging, type of gastrectomy, intraoperative blood loss (IBL), anastomotic leakage, and hospital stay were compared between the two groups. This study was registered as CTR2200059886. Results Out of 226 patients, 54 had early gastric carcinoma (EGC), while 172 had advanced gastric carcinoma (AGC). There were 64 patients in the high IFV group and 162 in the low IFV group. The high IFV group had significantly higher IBL mean values (p = 0.008). Therefore, having a high IFV was a risk factor for the occurrence of perioperative complications (p = 0.008). Conclusions High IFV estimated by MDCT prior to GC surgery was associated with increased IBL and postoperative complications. Incorporating this CT-IFV estimation into surgical fellowship programs may aid aspiring surgeons in selecting patients during independent practice in their learning curve and surgical practice for the most appropriate approach for treating GC patients.
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Affiliation(s)
- Jenifei Shah
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suyue Yu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyi Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Li
- School of Basci Med, Fouth Military Medical University, Xi’an, China
| | - Zhenglun Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial. J Pers Med 2022; 12:jpm12111904. [PMID: 36422080 PMCID: PMC9697147 DOI: 10.3390/jpm12111904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: To identify preoperative predictive factors for technically challenging laparoscopic appendectomy (LA) and the need for external help to laparoscopically complete the procedure. Methods: We analysed data from a two-year data lock on the Resident-1 multicentre registry. The operator classified each procedure following a five-grade Likert scale to define technical difficulty. We performed univariate analysis comparing Grade 1−3 versus 4−5 procedures and then built a logistic regression model to identify independent predictors of Grade 4−5 procedures defined as needing external help to complete a LA. Results: 561 patients were recruited from 2019 to 2021, and 485 patients were included in the final analysis due to missing data. A BMI > 30 kg/m2, preoperative CT scan, and the AIR score were independent preoperative predictors of complex LA with the need for external help to be completed. Patients undergoing such procedures were more affected by CA, had longer operative times, and had the worst postoperative outcomes. Conclusion: The preoperative identification of technically demanding LA could be helpful in optimising the preoperative planning, maximise surgeons’ preparedness, and include expert surgeons in the procedure earlier. Creating a scoring system for the technical difficulty of LA is desirable.
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Zhang J, Jiang L, Zhu X. A Novel Nomogram for Prediction of Early Postoperative Complications of Total Gastrectomy for Gastric Cancer. Cancer Manag Res 2021; 13:7579-7591. [PMID: 34629904 PMCID: PMC8495149 DOI: 10.2147/cmar.s333172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Accurate prediction of postoperative complications is especially important for the formulation of treatment plans for patients with total gastrectomy (TG) for gastric cancer (GC). The purpose of this study was to establish a risk assessment model for early postoperative complications. Methods This retrospective study involved 363 patients with GC who underwent TG from January 2019 to December 2020. The influencing factors were explored by univariate and multivariable logistic regression; then, a nomogram was established and verified by internal verification. Results Linear stapler (OR=2.501, P=0.030), age (OR=1.052, P =0.024), blood transfusion (yes) (OR=2.450, P =0.021), one-time consumables for surgery (or=1.000, P =0.022), number of total lymph nodes (OR=1.060, P =0.011) and number of positive lymph nodes (OR=1.054, P =0.029) were independent risk factors for early postoperative complications in TG, and nomogram model was constructed. The C-index of primary cohort, modeling cohort and validation cohort was 0.787, 0.754 and 0.912. The calibration curves showed good accuracy. Conclusion This study used the indicators available before and during surgery to establish a nomogram model for early postoperative complications of total gastrectomy for gastric cancer, which found that linear stapler (LS), blood transfusion, one-time consumables for surgery, number of total lymph nodes and number of positive lymph nodes were factors.
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Affiliation(s)
- Jiawen Zhang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Linhua Jiang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xinguo Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Abstract
PURPOSE Anastomotic leak (AL) following colorectal cancer resection is associated with considerable morbidity and mortality with an impact on recurrence rates and survival. The impact of obesity on AL rates is debated. This meta-analysis aims to investigate the relationship between obesity and AL. METHODS A search was conducted of the PubMed/MEDLINE, and Web of Science databases and included studies were split into Western and Asian groups based on population-specific body mass index (BMI) ranges for obesity. A meta-analysis was performed to assess the impact of obesity on AL rate following colorectal cancer resection. RESULTS Two thousand three hundred and four articles were initially screened. Thirty-one studies totaling 32,953 patients were included. Patients with obesity had a statistically significant increase in AL rate in all Western and Asian study groups. However, this increase was only clinically significant in the rectal anastomotic subgroups-Western: 10.8% vs 8.4%, OR 1.57 (1.01-2.44) and Asian: 9.4% vs 7.4%, OR 1.58 (1.07-2.32). CONCLUSIONS The findings of this analysis confirm that obesity is a significant risk factor for anastomotic leak, particularly in rectal anastomoses. This effect is thought to be primarily mediated via technical difficulties of surgery although metabolic and immunological factors may also play a role. Obesity in patients undergoing restorative CRC resection should be discussed and considered as part of the pre-operative counselling.
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Maruyama K, Shimada K, Makino A, Hisamune R, Shirota T, Gomi K. Effective and safe reduction in visceral fat using a formula diet in a short period before highly invasive endoscopic surgery - Case series. Int J Surg Case Rep 2021; 83:106026. [PMID: 34058461 PMCID: PMC8175398 DOI: 10.1016/j.ijscr.2021.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction We retrospectively assessed the efficacy and safety of use of short-term formula diet therapy to achieve preoperative reduction in visceral fat immediately prior to highly invasive endoscopic surgery. Presentation of case We reviewed 5 cancer patients who underwent thoracoscopic and/or laparoscopic-assisted esophagectomy or gastrectomy. The cases were those with a BMI ≥30 kg/m2 or waist circumference ≥100 cm. Patients replaced one meal out of the three main meals with one or two sachets of formula diet (170–340 kcal). The other two meals were set to 600 kcal. The dietary therapy was implemented approximately 1 month before the operation. Weight loss achieved after dietary therapy ranged from 6.4% to 14.1% (p < 0.01). With the exception of one case, the decrease in visceral fat area ranged from 17.0%–40.7% (p = 0.03). Postoperative complications were anastomotic insufficiency in two cases. Discussion Although the decreases of the visceral fat were effectively implemented, the adverse effects on postoperative complications must be examined in the farther study. Conclusion It was suggested that use of formula diet to achieve preoperative visceral fat reduction in a short period of time immediately prior to highly invasive endoscopic cancer surgery would be an effective and safe strategy. We assessed efficacy of formula diet therapy to highly invasive endoscopic surgery. The decrease in visceral fat area ranged from 17.0% to 40.7% (p = 0.03). It should be emphasized that there were no more serious life-threatening cardiopulmonary complications. Preoperative formula diet therapy may be an effective means to reduce visceral fat.
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Affiliation(s)
- Kiyotomi Maruyama
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
| | - Kou Shimada
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
| | - Arano Makino
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Ryo Hisamune
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Tomoki Shirota
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Kuniyuki Gomi
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
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Computed Tomography Assessment of Fat Distribution and Staple-Line Leak Risk After Sleeve Gastrectomy. Obes Surg 2021; 31:2011-2018. [PMID: 33409967 DOI: 10.1007/s11695-020-05199-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) has become the most frequent bariatric procedure and staple-line leak represents its most feared complication. Visceral obesity, a core component of the metabolic syndrome, has been associated with worst postoperative outcomes after various abdominal surgical procedures, and can be estimated by computed tomography (CT). The aim of this study was to assess the impact of radiologically determined visceral obesity in the risk of staple-line leak after SG. MATERIAL AND METHODS A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG. Several anthropometric variables were measured on a preoperative CT scan. Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. RESULTS During the study period, 377 patients were included in the analysis. The median BMI was 39.7 kg/m2 (36.5-43.5) and 8 patients (2.1%) presented a gastric leak. After multivariate analysis, visceral obesity defined by visceral fat area (VFA)/body surface area (BSA) ≥ 85 cm2/m2 was the only independent predictive factor for gastric leak (OR = 5312). CONCLUSION CT scan-assessed visceral obesity defined by a VFA/BSA ratio ≥ 85 cm2/m2 is associated with an increased risk of gastric leak after SG. Preoperatively radiological examination in patients suspected of visceral obesity would be useful to optimize preoperative management.
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Huang S, Chen M, Deng Y, Wang X, Lu X, Jiang W, Huang Y, Chi P. Mesorectal fat area and mesorectal area affect the surgical difficulty of robotic-assisted mesorectal excision and intersphincteric resection respectively in different ways. Colorectal Dis 2020; 22:1130-1138. [PMID: 32040248 DOI: 10.1111/codi.15012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
Abstract
AIM Many studies have demonstrated predictors of the difficulty of laparoscopic anterior resection for rectal cancer. Few studies focus on the influence of pelvic dimensions on robotic-assisted mesorectal excision (ME) and intersphincteric resection (ISR). This study aimed to evaluate the influences of the mesorectal fat area (MFA) and mesorectal area on the difficulty of robotic sphincter-saving surgery. METHODS We included 156 patients with middle and low rectal cancer who underwent robotic sphincter-saving surgery. Clinical and anatomical factors, including the pelvic dimensions, were collected. Linear regression was performed for variables associated with surgical duration. We also performed subgroup analyses for robotic-assisted ME and ISR. Logistic regression was used to find variables associated with transanal dissection. RESULTS For patients with middle or low rectal cancer, the sacral length and tumour distance from the anal verge were independently associated with surgical duration. The pT stage, sacral length and the MFA were independent predictors for the surgical duration of robotic-assisted ME. By contrast, a small mesorectal area was independently related to a longer duration of robotic-assisted ISR. The pelvic outlet length was independently associated with the use of transanal dissection for ISR. CONCLUSION It is suggested that a large MFA could affect the difficulty of ME in robotic-assisted ME, while a small mesorectal area could increase the surgical difficulty of robotic-assisted ISR for low rectal cancer. Besides, the pelvic outlet length was associated with the use of transanal dissection. Further studies are needed to validate the results and draw more scientific conclusions.
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Affiliation(s)
- S Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - M Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Y Deng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - X Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - X Lu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - W Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Y Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - P Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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14
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Danwang C, Agbor VN, Bigna JJ. Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis. BMC Surg 2020; 20:194. [PMID: 32867744 PMCID: PMC7457363 DOI: 10.1186/s12893-020-00848-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. Methods We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. Results Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55–4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54–2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58–5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05–3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02–14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13–3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16–2.34; I2 = 19.5%). Conclusions This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.
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Affiliation(s)
- Celestin Danwang
- Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium. .,Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Clinical Research, Health Education and Research Organisation (HERO), Buea, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Paris, France
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15
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Evaluation of nutritional status of foreign students at King Saud University, Kingdom of Saudi Arabia. Public Health Nutr 2020; 24:43-51. [PMID: 32844736 DOI: 10.1017/s1368980020002864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study was conducted to assess the nutritional status and associated risk factors among foreign students residing at King Saud University for different periods and to explore its correlations. DESIGN A cross-sectional study was conducted during the spring semester of 2018. A total of 400 male students aged 18-35 years had participated in the current study after signing a written consent form according to Helsinki Declaration. SETTING A structural questionnaire was used to collect data on daily food intake and habits and socio-economic characteristics. Nutrients of food intake were assessed using the Esha programme and compared with that of dietary requirement intake (DRI). A body composition analyser was used to measure body fat (BF), visceral fat (VF) and BMI. Spearman correlation coefficients and simple regression analysis were performed to determine associations between variables. PARTICIPANTS Foreign students residing for different periods (<6 months: 200 students and >6 months: 200 students) were used as subjects. RESULTS The students who stayed <6 months consumed lower level of some nutrients than that of the DRI compared with those stayed >6 months. Overweight and obesity were more common among students who stayed >6 months with high values of BF and VF. Several risk factors were positively or negatively correlated with the students' nutrition proxies. CONCLUSION Most of the students who stayed >6 months are suffered from overweight. Some independent variables were found to be significantly correlated with the students' nutrition proxies either positively or negatively.
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16
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Fragkos KC, Thong D, Cheung K, Thomson HJ, Windsor AC, Engledow A, McCullough J, Mehta SJ, Rahman F, Plumb AA, Di Caro S. Adipose tissue imaging as nutritional predictors in patients undergoing enterocutaneous fistula repair. Nutrition 2020; 73:110722. [DOI: 10.1016/j.nut.2020.110722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 12/22/2022]
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17
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Gurunathan U, Rapchuk IL, Dickfos M, Larsen P, Forbes A, Martin C, Leslie K, Myles PS. Association of Obesity With Septic Complications After Major Abdominal Surgery: A Secondary Analysis of the RELIEF Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1916345. [PMID: 31774526 PMCID: PMC6902846 DOI: 10.1001/jamanetworkopen.2019.16345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Body mass index (BMI) has been the most common obesity measure to assess perioperative risk; however, cardiometabolic risk is associated with the burden of visceral fat. Definitive evidence on the association of visceral fat measures, such as waist circumference and waist-to-hip ratio (WHR), with postoperative complications is lacking. OBJECTIVE To compare the value of waist circumference with the value WHR and BMI in predicting adverse outcomes, including major septic complications and persistent disability, following major abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS This planned secondary analysis of the Restrictive vs Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) randomized clinical trial took place at 47 centers in 7 countries between October 2013 and September 2016, with 90-day follow-up. A total of 2954 adult RELIEF participants were coenrolled in this secondary analysis. Data analysis took place from December 2018 to September 2019. EXPOSURES Waist circumference, WHR, and BMI measurements. MAIN OUTCOMES AND MEASURES The primary outcomes were 30-day major septic complications and 90-day persistent disability or death. RESULTS Of 2954 eligible participants, 2755 were included (mean [SD] age, 65.9 [12.9] years; 1426 [51.8%] men) in the final analysis. A total of 564 participants (20.6%) experienced at least 1 major septic complication within 30 days after surgery (sepsis, 265 [9.7%]; surgical site infection, 409 [14.9%]; anastomotic leak, 78 [2.8%]; pneumonia, 104 [3.8%]). Waist circumference had a statistically significantly larger odds ratio (OR) and discrimination indices as well as a smaller prediction error than WHR or BMI for 30-day major septic complications or death (waist circumference: OR, 1.44; 95% CI, 1.28-1.62; P < .001; area under the receiver operating characteristic curve, 0.641; net reclassification index, 0.266; integrated discrimination improvement [score × 104], 152.98; Brier score, 0.162; WHR: OR, 1.15; 95% CI, 1.03-1.28; P = .01; area under the receiver operating characteristic curve, 0.621; net classification index, 0.199; integrated discrimination improvement [score × 104], 28.47; Brier score, 0.164; BMI: OR, 1.33; 95% CI, 1.17-1.50; P < .001; area under the receiver operating characteristic curve, 0.629; net reclassification index, 0.205; integrated discrimination improvement [score × 104], 85.61; Brier score, 0.163) but not for any other outcomes. CONCLUSIONS AND RELEVANCE In this secondary analysis of the RELIEF randomized clinical trial, waist circumference was observed to be superior to other adiposity indices in predicting 30-day major septic complications alone or in conjunction with death following elective major abdominal surgery. Findings suggest that waist circumference is a useful adiposity measure that should be incorporated in preoperative risk assessment for such complications. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01424150.
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Affiliation(s)
- Usha Gurunathan
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ivan L. Rapchuk
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marilla Dickfos
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of General Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Peter Larsen
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Leslie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Integrated Critical Care Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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18
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Son IT, Kim DW, Choe EK, Kim YH, Lee KH, Ahn S, Kang SI, Kim MJ, Oh HK, Kim JS, Kang SB. Oncologic evaluation of obesity as a factor in patients with rectal cancer undergoing laparoscopic surgery: a propensity-matched analysis using body mass index. Ann Surg Treat Res 2019; 96:86-94. [PMID: 30746356 PMCID: PMC6358594 DOI: 10.4174/astr.2019.96.2.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose This study evaluated the oncologic impact of obesity, as determined by body mass index (BMI), in patients who underwent laparoscopic surgery for rectal cancer. Methods The records of 483 patients with stage I-III rectal cancer who underwent laparoscopic surgery between June 2003 and December 2011 were reviewed. A matching model based on BMI was constructed to balance obese and nonobese patients. Cox hazard regression models for overall survival (OS) and disease-free survival (DFS) were used for multivariate analyses. Additional analysis using visceral fat area (VFA) measurement was performed for matched patients. The threshold for obesity was BMI ≥ 25 kg/m2 or VFA ≥ 130 cm2. Results The score matching model yielded 119 patients with a BMI ≥ 25 kg/m2 (the obese group) and 119 patients with a BMI < 25 kg/m2 (the nonobese group). Surgical outcomes including operation time, estimated blood loss, nil per os periods, and length of hospital stay did not differ between the obese and the nonobese group. The retrieved lymph node numbers and pathologic CRM positive rate were also similar in between the 2 groups. After a median follow-up of 48 months (range, 3-126 months), OS and DFS rates were similar between the 2 groups. A tumor location-adjusted model for overall surgical complications showed that a BMI ≥ 25 kg/m2 were not risk factors. Multivariable analyses for OS and DFS showed no significant association with a BMI ≥ 25 kg/m2. Conclusion Obesity was not associated with long-term oncologic outcomes in patients undergoing laparoscopic surgery for rectal cancer in the Asian population.
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Affiliation(s)
- Il Tae Son
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Kyung Choe
- Seoul National University Hospital Gangnam Center, Seoul, Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myung Jo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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19
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Impact of intra-peritoneal fat distribution on intra-operative bleeding volume with D2 lymphadenectomy in Chinese patients with gastric cancer. Asian J Surg 2018; 42:768-774. [PMID: 30573172 DOI: 10.1016/j.asjsur.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To explore the quantitative measurements and evaluation of intra-peritoneal fat distribution by MDCT and its significance in predicting intra-operative bleeding volume during D2 lymphadenectomy in gastric cancer (GC) patients. METHODS From June 2016 to September 2017, GC patients scheduled for open gastrectomy with D2 lymph-node dissection were enrolled. According to the BMI, the subjects were then classified as normal BMI(BMI<25 kg/m2); overweight (BMI = 25-30 kg/m2) and obese (BMI≥30 kg/m2). According to the intraoperative blood loss (IBL), the patients were further separated into high IBL (IBL; ≥ 300 ml) or low IBL (<300 ml). Clinicopathological parameters between the groups were statistically compared and univariate and multivariate analysis were used to identify predictive factors such as intra-peritoneal fat areas (IFA) and intra-peritoneal fat areas ratio (IFAR) for high IBL. RESULTS A total of 226 patients were included in the study where 53 patients underwent distal while 173 underwent total gastrectomy. According to the BMI classification, there were 25 normal BMI, 108 overweight and 25 obese subjects. According to the IBL, there were 98 high IBL and 128 low IBL subjects. IFA and IFAR were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in any other clinicopathological factors between the high IBL group and the low IBL group. Multivariate analysis revealed that high IFA and IFAR independently predicted high IBL. CONCLUSION The use of MDCT to evaluate the precise distribution of abdominal fat during preoperative examination can prompt surgeons to develop techniques to decrease intraoperative bleeding in obese patients. Nevertheless, it is yet necessary to be surgically more meticulous when dealing with patients with high IFA or high IFA/IFAR in order to improve the outcome of D2 gastrectomy.
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20
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Christakis I, Ng CS, Chen C, Yiin YH, Grubbs EG, Perrier ND, Lee JE, Graham PH. Operation duration and adrenal gland size, but not BMI, are correlated with complication rate for posterior retroperitoneoscopic adrenalectomy for benign diseases. Surgery 2018; 165:637-643. [PMID: 30482519 DOI: 10.1016/j.surg.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to determine whether obesity is correlated with complications after posterior retroperitoneoscopic adrenalectomy for benign diseases and to develop surrogate markers of abdominal fat in preoperative computed tomography. METHODS We conducted a retrospective chart review of all patients who had undergone posterior retroperitoneoscopic adrenalectomy and preoperative computed tomography between January 1, 2008 and December 31, 2015. The cross-sectional components of fat assessed by computed tomography included total fat area, subcutaneous fat area, retroperitoneal fat area, and peritoneal fat area. The patients were grouped into 2 categories according to the absence or presence of a postoperative complication (the no-complications group and the complications group, respectively). RESULTS Of 116 study patients, 20 patients (17%) had a postoperative complication. Operations of greater duration and smaller adrenal gland size were significantly correlated with complications both in univariate and multivariate analyses. Body mass index, total fat area, subcutaneous fat area, retroperitoneal fat area, peritoneal fat area, and distance of skin to muscle (in axial and sagittal images) correlated with complications in univariate analysis but not in multivariate analysis. In the no-complications group, the removed adrenal gland was larger than that removed in the complications group (6 vs 4 cm, respectively, P = .001), whereas the complications group had a greater operative duration (139 vs 104 min, respectively, P = .001) and a greater duration of hospital stay (3 days vs 1 day, respectively, P = .001). CONCLUSION In this study, operations of greater duration and smaller adrenal gland size were better predictors of complications after posterior retroperitoneoscopic adrenalectomy for benign disease than measures of obesity, including body mass index.
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Affiliation(s)
- Ioannis Christakis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chaan S Ng
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chao Chen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yeh Hung Yiin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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The impact of the mesorectal apparent diffusion coefficient value on surgical difficulty in laparoscopic anterior resection for rectal cancer. Surg Today 2018; 49:239-244. [PMID: 30341539 DOI: 10.1007/s00595-018-1727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/22/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed to clarify the impact of the apparent diffusion coefficient (ADC) value of the mesorectum from preoperative magnetic resonance imaging (MRI) on surgical difficulty in laparoscopic anterior resection (Lap-AR) for rectal cancer. METHODS In total, 67 patients who had undergone curative Lap-AR for rectal cancer in our hospital from January 2008 to March 2015 and had preoperative MRI findings available were included. We randomly calculated the average ADC in three regions of the mesorectum at the level of the upper edge of the superior border of the femur. Univariate and multivariate analyses were performed to evaluate the correlation between the patients' clinicopathological characteristics, including the ADC value and short-term surgical outcomes. RESULTS The univariate analysis revealed that a lower ADC value was associated with a significantly increased operative blood loss (p = 0.008) and prolonged operative time (p < 0.001). The multivariate analysis adjusted for the body mass index, anal verge, tumor location, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for a prolonged operative time (R2 = 0.6003, p < 0.001). Furthermore, the multivariate analysis adjusted for the body mass index, anal verge, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for an increased blood loss (R2 = 0.4345, p = 0.008). CONCLUSION A lower ADC value of the mesorectum might be a predictor of surgical difficulty in Lap-AR for rectal cancer.
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22
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Goulart A, Malheiro N, Rios H, Sousa N, Leão P. Influence of Visceral Fat in the Outcomes of Colorectal Cancer. Dig Surg 2018; 36:33-40. [PMID: 29566371 DOI: 10.1159/000486143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
AIM To determine the relationship of visceral fat (VF) with the surgical outcome of the patients with colorectal cancer (CRC) submitted to curative surgery. METHODS Retrospective analysis of all patients submitted to CRC surgery during 3 years with a minimum of 5 years of follow-up. We assessed the length of hospital stay, complications, pathologic reports, surgical re-interventions and hospital re-admissions, relapses, survival time and disease-free time. VF was calculated based on patients' pre-operative CT-scan. The patients were divided into quartiles according to the VF area. Linear regression models and logistic regression models were used to establish a relationship between VF and all data collected. RESULTS The study included 199 patients (129 with colon cancer [CC] and 70 with rectal cancer). The average area of VF was 115.7 cm2. Patients with CRC revealed a direct relationship between VF and postoperative complications (p = 0.043), anastomotic leakage (p = 0.009) and re-operation (p = 0.005). The subgroup of patients with CC had an inverse association between VF and lymph nodes harvested (p = 0.027). Survival analyses did not reveal significant differences. CONCLUSION VF has an influence on postoperative complications, anastomotic leakage and re-operation. A negative influence of VF on lymph nodes harvested was observed on CC patients.
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Affiliation(s)
- André Goulart
- Department of General Surgery, Hospital de Braga, Braga, .,Life and Health Sciences Research Institute (ICVS), University of Minho, Braga,
| | - Nuno Malheiro
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Hugo Rios
- Department of General Surgery, Hospital de Braga, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
| | - Pedro Leão
- Department of General Surgery, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
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Abstract
BACKGROUND The prevalence of obesity is as high as one-third of the adult population in the ultrasound. Obese patients operated for rectal cancer are less likely to undergo sphincter-preserving surgery, and have an increased morbidity and mortality. We aim to report the outcomes of transanal-endoscopic-microsurgery (TEM) in obese patients with benign and malignant neoplasms. MATERIALS AND METHODS An analysis was carried out of all patients undergoing TEM at a single institution between 2004 and 2015. Clinical, demographic, and pathologic data were analyzed in respect to BMI; a dichotomous variable was created categorizing the patients in this retrospective case series as either obese (BMI≥30) or nonobese (BMI<30). RESULTS Of the 158 patients who underwent TEM during the study period, 51 (32%) were obese and 107 (68%) were nonobese. No significant differences were found in terms of patients' demographics and tumor characteristics. There were no significant differences in operative time [105 min (range: 75-170) and 98 (range: 56-170), respectively, P=0.2], hospital length of stay [3 days (range: 2-6) and 4 (range: 2-12), respectively, P=0.48], or complication rates (20 and 23%, respectively, P=0.68). CONCLUSION TEM is a safe procedure for rectal neoplasms in the obese population. We found no difference in surgical time and completeness of specimen resection, and no increase in complications or length of stay in the hospital in obese versus nonobese patients. As for selected high risk patients, the TEM may be of benefit in obese patients with T1/T2N0M0 rectal cancer.
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24
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Laparoscopic colectomy in the obese, morbidly obese, and super morbidly obese: when does weight matter? Int J Colorectal Dis 2017; 32:1447-1451. [PMID: 28710609 DOI: 10.1007/s00384-017-2865-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have demonstrated that obese patients (BMI >30) undergoing laparoscopic colectomy have longer operative times and increased complications when compared to non-obese cohorts. However, there is little data that specifically evaluates the outcomes of obese patients based on the degree of their obesity. The aim of this study was to evaluate the impact of increasing severity of obesity on patients undergoing laparoscopic colectomy. METHODS A retrospective review was performed of all patients undergoing laparoscopic colectomy between 1996 and 2013. Patients were classified according to their BMI as obese (BMI 30.0-39.9), morbidly obese (BMI 40.0-49.9), and super obese (BMI >50). Main outcome measures included conversion rate, operative time, estimated blood loss, post-operative complications, and length of stay. RESULTS There were 923 patients who met inclusion criteria. Overall, 604 (65.4%), 257 (27.9%), and 62 (6.7%) were classified as obese (O), morbidly obese (MO), and super obese (SO), respectively. Clinicopathologic characteristics were similar among the three groups. The SO group had significantly higher conversion rates (17.7 vs. 7 vs. 4.8%; P = 0.031), longer average hospital stays (7.1 days vs. 4.9 vs. 3.4; P = 0.001), higher morbidity (40.3 vs. 16.3 vs. 12.4%; P = 0.001), and longer operative times (206 min vs. 184 vs. 163; P = 0.04) compared to the MO and O groups, respectively. The anastomotic leak rate in the SO (4.8%; P = 0.027) and MO males (4.1%; P = 0.033) was significantly higher than MO females (2.2%) and all obese patients (1.8%). CONCLUSION Increasing severity of obesity is associated with worse perioperative outcomes following laparoscopic colectomy.
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25
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Saeed N, Shridhar R, Almhanna K, Hoffe S, Chuong M, Meredith K. CT-based assessment of visceral adiposity and outcomes for esophageal adenocarcinoma. J Gastrointest Oncol 2017; 8:833-841. [PMID: 29184687 DOI: 10.21037/jgo.2017.07.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Various methods of quantifying and correlating obesity to outcomes for patients with esophageal adenocarcinoma (EA) have been evaluated. Published data suggest that quantification of adiposity may be more accurate than body mass index (BMI) as a prognostic factor. We report our analysis of adiposity as a prognostic factor in a series of patients with EA. Methods This single institution retrospective review included patients with EA who underwent esophagectomy from 1994-2008. Patients with BMI <20 were excluded. Using the preoperative CT scan, the visceral (VFA), subcutaneous (SFA), and total abdominal fat (TFA) areas were calculated. Each was contoured on a Siemens Leonardo workstation at the level of the iliac crest (L4/5). The Hounsfield threshold was -30 to -130. Outcomes were analyzed using Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed using the Cox proportion hazard regression model. Results We identified 126 patients for the analysis. There were no statistically significant differences in overall survival or disease-free survival between groups above and below the medians for TFA, SFA, or VFA/SFA ratio. However, an increase in VFA was significantly associated with worsened OS and DFS when we further classified patients into quartiles. Patients with VFA ≥182 cm2 had larger tumor size (P=0.016), fewer involved lymph nodes (P=0.047), longer operating times (P=0.032), and were more likely to be males (P=0.042). Conclusions Published data have demonstrated an association between treatment outcomes and degree of adiposity; our study found a correlation between VFA and OS and DFS in patients with EA. Median TFA, SFA, and VFA/SFA were not prognostic on MVA. While VFA >182 cm2 was associated with larger tumors, there were also fewer lymph nodes harvested in this group.
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Affiliation(s)
- Nadia Saeed
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, University of Central Florida, Orlando, FL, USA
| | - Khaldoun Almhanna
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Chuong
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth Meredith
- Department Gastrointestinal Oncology, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA
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Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2017; 27:104-109. [PMID: 28212258 PMCID: PMC5378004 DOI: 10.1097/sle.0000000000000378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Our current study was conducted to identify patients' anatomic, pathologic, and clinical factors to predict difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer. MATERIALS AND METHODS Records of 117 consecutive patients with rectal cancer 2 to 5 cm from the anal verge were retrospectively reviewed. Using univariate and multivariate linear or logistic regression models, standardized operative time and blood loss, as well as postoperative morbidity were utilized as endpoints to screen patients' multiple variables to predict operative difficulty. RESULTS Multivariate linear regression analysis showed body mass index (BMI) (estimate=0.07, P=0.0056), interspinous distance (estimate=-0.02, P=0.0011), tumor distance from anal verge (estimate=-0.17, P=0.0355), prior abdominal surgery (estimate=0.51, P=0.0180), preoperative chemoradiotherapy (estimate=0.67, P=0.0146), and concurrent diseases (hypertension and/or diabetes mellitus) (estimate=0.49, P=0.0122) are predictors for standardized operative time. Age (estimate=0.02, P=0.0208) and concurrent diseases (estimate=0.43, P=0.0476) were factors related to standardized blood loss. BMI (estimate=0.15, P=0.0472) was the only predictor for postoperative morbidity based on logistic regression analysis. CONCLUSIONS Age, BMI, interspinous distance, tumor distance from anal verge, prior abdominal surgery, preoperative chemoradiotherapy, and concurrent diseases influence the difficulty of performing laparoscopic abdominoperineal resection for ultra-low rectal cancer. Standardized operative time allows researchers to amass samples by pooling data from all published studies, thus building reliable models to predict operative difficulty for clinical use.
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Prediction of Anastomotic Leakage After Laparoscopic Low Anterior Resection in Male Rectal Cancer by Pelvic Measurement in Magnetic Resonance Imaging. Surg Laparosc Endosc Percutan Tech 2017; 27:54-59. [PMID: 28092330 PMCID: PMC5287437 DOI: 10.1097/sle.0000000000000366] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Anastomotic leakage after laparoscopic low anterior resection in male rectal cancer patients with a narrow pelvis cannot be easily resolved. The objective of this study is to assess numerical information of narrow pelvis and to determine whether prediction of morbidity can be possible. METHODS Retrospective medical record review was performed. From July 2007 to January 2013, 43 consecutive male patients with low rectal cancer who underwent laparoscopic low anterior resection were divided into the anastomotic leakage-negative group and anastomotic leakage-positive group. Eleven anatomic parameters were measured from preoperative magnetic resonance imaging of pelvis and a new index called "pelvic index" was calculated. RESULTS The pelvic index (difference between the interspinous distance and the diameter of the mesorectum divided by the depth of the cavity of the lesser pelvis) in the leakage-positive group was significantly smaller than that in the negative group (P=0.038). Comparison between those 2 groups at the border of the cut-off value of the pelvic index (13.0) showed a significant difference. CONCLUSIONS Preoperative assessment by the pelvic index can predict the narrow pelvis and risk of anastomotic leakage.
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Martin L, Seton G, Aldred B, Hopkins P, Chan J, Heilbrun ME, Mone M, Scaife C, Peche W. When body mass index fails to measure up: perinephric and periumbilical fat as predictors of operative risk. Am J Surg 2016; 212:1039-1046. [DOI: 10.1016/j.amjsurg.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 12/12/2022]
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Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery 2016; 161:680-693. [PMID: 27712873 DOI: 10.1016/j.surg.2016.08.030] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/02/2016] [Accepted: 08/20/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between sarcopenia and postoperative outcomes has been well reported. However, the impact of different sarcopenia stages on postoperative outcomes has never been investigated. METHODS We conducted a large, prospective study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015. Sarcopenia was staged as "presarcopenia," "sarcopenia," and "severe sarcopenia" according to the definition of the European Working Group on Sarcopenia in Older People. Univariate and multivariate analyses evaluating the risk factors for total, surgical, and medical complications were performed. RESULTS A total of 470 patients were included, in which 20.6%, 10%, and 6.8% of the patients were identified as having "presarcopenia," "sarcopenia," and "severe sarcopenia," respectively. Postoperative complications, duration of hospital stays, and costs increased with advancing sarcopenia stages. Severe sarcopenia, visceral fat area to total abdominal muscle area ratio, American Society of Anesthesiologists grade III, and tumor located at the cardia were independent risk factors for total complications. Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications. Presarcopenia, sarcopenia, and severe sarcopenia were all identified as independent risk factors for medical complications, as well as age ≥75 years and Charlson Comorbidity Index. CONCLUSION Patients had worse postoperative outcomes after gastric cancer operation with advancing sarcopenia stages. Severe sarcopenia, but not presarcopenia or sarcopenia, was an independent risk factor for total postoperative complications. The 3 sarcopenia stages independently influence medical but not surgical complications. Recognizing sarcopenia stages is important for preoperative risk stratification.
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Matsuzaki H, Ishihara S, Kawai K, Murono K, Otani K, Yasuda K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Yamaguchi H, Watanabe T. Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study. Surg Today 2016; 47:627-635. [DOI: 10.1007/s00595-016-1421-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 08/26/2016] [Indexed: 12/14/2022]
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Chen B, Zhang Y, Zhao S, Yang T, Wu Q, Jin C, He Y, Wang Z. The impact of general/visceral obesity on completion of mesorectum and perioperative outcomes of laparoscopic TME for rectal cancer: A STARD-compliant article. Medicine (Baltimore) 2016; 95:e4462. [PMID: 27603340 PMCID: PMC5023862 DOI: 10.1097/md.0000000000004462] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate the impact of visceral obesity on laparoscopic total mesorectal excision (TME) and decide the best index to reflect completion of mesorectum and perioperative outcomes.Patients with rectal cancer who underwent laparoscopic TME were enrolled. The data including body mass index (BMI), visceral fat area (VFA), visceral fat area/body surface area (VFA/BSA), mesorectum fat ratio (MFR), pelvic fat area (PFA), pelvic fat ratio (PFR), completion of mesorectum, and other perioperative outcomes were collected. Data were analyzed.A total of 322 patients were enrolled between 2011 and 2014. There was no significantly difference between the BMI groups on completion of mesorectum and other outcomes (P ≥ 0.05). However, in VFA groups, completion of mesorectum (P = 0.002), operative time (P = 0.02), and incision length (P = 0.02) were significantly different. In VFA/BSA groups, completion of mesorectum (P = 0.002) and incision length (P = 0.009) were significantly different. When MFR was equal to 0.48, completion of mesorectum (P = 0.002), operative time (P = 0.001), incision length (P = 0.03), and blood loss (P = 0.04) were significantly different between the 2 groups. In PFA and PFR groups, there was no significantly difference (P ≥ 0.05). After the analysis of logistic regression, only VFA was the risk factor of incomplete mesorectum excision.BMI does not reflect the impact of obesity on laparoscopic rectal surgery. VFA is a better index in predicting the influence of visceral obesity on surgical quality and difficulty of laparoscopic rectal surgery than VFA/BSA and MFR.
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Affiliation(s)
- Bingchen Chen
- The Surgical Department of Coloproctology, Zhejiang Provincial People's Hospital
| | - Yuanchuan Zhang
- Department of General Surgery, The Third People's Hospital of Chengdu
| | - Shuang Zhao
- Department of Gastrointestinal Surgery, West China Hospital
| | - Tinghan Yang
- Department of Gastrointestinal Surgery, West China Hospital
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital
| | - Chengwu Jin
- Department of Gastrointestinal Surgery, West China Hospital
| | - Yazhou He
- Department of Gastrointestinal Surgery, West China Hospital
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital
- Correspondence: Ziqiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang No. 37, Chengdu 610041, Sichuan Province, China (e-mail: )
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Takeuchi M, Ishii K, Seki H, Yasui N, Sakata M, Shimada A, Matsumoto H. Excessive visceral fat area as a risk factor for early postoperative complications of total gastrectomy for gastric cancer: a retrospective cohort study. BMC Surg 2016; 16:54. [PMID: 27494994 PMCID: PMC4974690 DOI: 10.1186/s12893-016-0168-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/30/2016] [Indexed: 01/10/2023] Open
Abstract
Background Obesity is a known risk factor for complications after digestive surgery. Body mass index (BMI) is commonly used as an index of obesity but does not always reflect the degree of obesity. Although some studies have shown that high visceral fat area (VFA) is associated with poor outcomes in digestive surgery, few have examined the relationship between VFA and total gastrectomy. In this study, we demonstrated that VFA is more useful than BMI in predicting complications after total gastrectomy. Methods Seventy-five patients who underwent total gastrectomy for gastric cancer were enrolled in this study; they were divided into two groups: a high-VFA group (n = 26, ≥100 cm2) and a low-VFA group (n = 49, <100 cm2). We retrospectively evaluated the preoperative characteristics and surgical outcomes of all patients and examined postoperative complications within 30 days of surgery (including cardiac complications, pneumonia, ileus, anastomotic leakage, pancreatic fistula, incisional surgical site infection [SSI], abdominal abscess, and hemorrhage). Results The incidence of anastomotic leakage (p = 0.03) and incisional SSI (p = 0.001) were higher in the high-VFA group than in the low-VFA group. No significant differences were observed in the other factors. We used univariate analysis to identify risk factors for anastomotic leakage and incisional SSI. Age and VFA were risk factors for anastomotic leakage, and BMI and VFA were risk factors for incisional SSI. A multivariate analysis including these factors found that only VFA was a predictor of anastomotic leakage (hazard ratio [HR] 4.62; 95 % confidence interval [CI] 1.02–21.02; p = 0.048) and incisional SSI (HR 4.32; 95 % CI 1.18–15.80; p = 0.027]. Conclusions High VFA is more useful than BMI in predicting anastomotic leakage and SSI after total gastrectomy. Therefore, we should consider the VFA value during surgery
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Affiliation(s)
- Masashi Takeuchi
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
| | - Kenjiro Ishii
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan.
| | - Hiroaki Seki
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
| | - Nobutaka Yasui
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
| | - Michio Sakata
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
| | - Akihiko Shimada
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
| | - Hidetoshi Matsumoto
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, 220-8521, Japan
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Cleveland E, Peirce G, Brown S, Freemyer J, Rice W, Lee L, Coviello L, Davis KG. A short-duration restrictive diet reduces visceral adiposity in the morbidly obese surgical patient. Am J Surg 2016; 212:927-930. [PMID: 27242218 DOI: 10.1016/j.amjsurg.2016.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aims to determine if visceral obesity can be reduced after a brief preoperative diet in obese patients. METHODS Forty morbidly obese patients were placed on a 1,000 kCal per day diet for 14 days before bariatric surgery. Patients had weight measurements and an abdominal ultrasound performed on days 1 and 14. The ultrasound measured visceral obesity using the distance between the abdominal muscle and the aorta, the fat thickness of the perinephric space, and the distance between the abdominal muscle and splenic vein. Mesenteric fat burden was calculated and compared. RESULTS Thirty-eight patients (95%) lost weight on the diet, with a mean loss of 5.2 lbs. Twenty-five patients (63%) had a reduction in mesenteric fat. The average visceral obesity lost was 7.76 cm3 or 3% of the visceral adiposity of the average obese patient (250 cm3). CONCLUSIONS A short preoperative calorie restricting diet is well tolerated and results in a reduction in visceral obesity.
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Affiliation(s)
- Elaine Cleveland
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Greg Peirce
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Shaun Brown
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Josiah Freemyer
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - William Rice
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Llewellyn Lee
- Department of Radiology, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Lisa Coviello
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Kurt G Davis
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
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Chen W, Li Q, Fan Y, Li D, Jiang L, Qiu P, Tang L. Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique. PLoS One 2016; 11:e0151773. [PMID: 26992004 PMCID: PMC4798689 DOI: 10.1371/journal.pone.0151773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/03/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Laparoscopic sphincter-preserving low anterior resection for rectal cancer is a surgery demanding great skill. Immense efforts have been devoted to identifying factors that can predict operative difficulty, but the results are inconsistent. OBJECTIVE Our study was conducted to screen patients' factors to build models for predicting the operative difficulty using well controlled data. METHOD We retrospectively reviewed records of 199 consecutive patients who had rectal cancers 5-8 cm from the anal verge. All underwent laparoscopic sphincter-preserving low anterior resections with total mesorectal excision (TME) and double stapling technique (DST). Data of 155 patients from one surgeon were utilized to build models to predict standardized endpoints (operative time, blood loss) and postoperative morbidity. Data of 44 patients from other surgeons were used to test the predictability of the built models. RESULTS Our results showed prior abdominal surgery, preoperative chemoradiotherapy, tumor distance to anal verge, interspinous distance, and BMI were predictors for the standardized operative times. Gender and tumor maximum diameter were related to the standardized blood loss. Temporary diversion and tumor diameter were predictors for postoperative morbidity. The model constructed for the operative time demonstrated excellent predictability for patients from different surgeons. CONCLUSIONS With a well-controlled patient population, we have built a predictable model to estimate operative difficulty. The standardized operative time will make it possible to significantly increase sample size and build more reliable models to predict operative difficulty for clinical use.
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Affiliation(s)
- Weiping Chen
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
- * E-mail:
| | - Qiken Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - Yongtian Fan
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - Lai Jiang
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - Pengnian Qiu
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
| | - Lilong Tang
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China
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Effect of Visceral Obesity on Surgical Outcomes of Patients Undergoing Laparoscopic Colorectal Surgery. World J Surg 2016; 39:2343-53. [PMID: 25917197 DOI: 10.1007/s00268-015-3085-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Visceral obesity has been known to be more pathogenic than body mass index (BMI). There have been a few reports about the association between visceral obesity and surgical outcomes in laparoscopic surgery. The aim of this study was to evaluate the effect of visceral obesity on surgical outcomes undergoing laparoscopic colorectal surgery. METHODS Between January 2005 and December 2012, a total of 543 patients who underwent laparoscopic resection for colorectal cancer and had available computed tomography (CT) scans were included in this retrospective study. Visceral fat volumes (VFVs) were measured in preoperative CT scans from S1 to 12.5 cm above. Patients were divided into an obese group and a non-obese group according to VFV and BMI. Obesity was defined by VFV ≥1.92 dm(3) (75% value of VFV) or BMI ≥25 kg/m(2). RESULTS There were 136 (25.0%) and 150 (27.6%) obese patients according to VFV and BMI, respectively. The high VFV group had a longer operative times (165.2 ± 84.4 vs. 146.1 ± 58.9 min; P = 0.016), higher blood loss during surgery (132.5 ± 144.8 vs. 98.3 ± 109.6 ml; P = 0.012), more frequent conversion to laparotomy (5.9 vs. 1.5%; P = 0.010), and more frequent major complications (Dindo score ≥3; 11.0 vs. 4.7%; P = 0.008), whereas there was no significant difference between the high and low BMI groups. High VFV was a significant independent risk factor for open conversion (odds ratio 4.964, 95% confidence interval 1.336-18.438, P = 0.017). CONCLUSIONS Visceral obesity can be a more clinically useful predictor than BMI in predicting surgical outcomes for laparoscopic colorectal cancer surgery.
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Harrison OJ, Smart NJ, White P, Brigic A, Carlisle ER, Allison AS, Ockrim JB, Francis NK. Operative time and outcome of enhanced recovery after surgery after laparoscopic colorectal surgery. JSLS 2016; 18:265-72. [PMID: 24960491 PMCID: PMC4035638 DOI: 10.4293/108680813x13753907291918] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives: Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery. Methods: Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days). Results: Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] = 2.02; 95% confidence interval [CI], 1.05–3.90; P = .027), and blood loss of >500 mL (OR = 3.114; 95% CI, 1.501–6.462, P = .002). Conclusions: Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.
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Affiliation(s)
- Oliver J Harrison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT, UK.
| | - Neil J Smart
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
| | - Paul White
- University of the West of England, Bristol, UK
| | - Adela Brigic
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
| | - Elinor R Carlisle
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
| | - Andrew S Allison
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
| | - Jonathan B Ockrim
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK
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Yu H, Joh YG, Son GM, Kim HS, Jo HJ, Kim HY. Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer. Ann Coloproctol 2016; 32:20-6. [PMID: 26962532 PMCID: PMC4783507 DOI: 10.3393/ac.2016.32.1.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/13/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection. Methods The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80). Results No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 ± 1.0 vs. 13.5 ± 1.2, respectively, P = 0.001). Conclusion Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.
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Affiliation(s)
- Hyeon Yu
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong-Geul Joh
- Department of Surgery, Hansol Hospital, Seoul, Korea
| | - Gyung-Mo Son
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hyun-Sung Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hong-Jae Jo
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
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Rectal cancer with synchronous liver metastases: Do we have a clear direction? Eur J Surg Oncol 2015; 41:1570-7. [DOI: 10.1016/j.ejso.2015.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 12/12/2022] Open
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Cakir H, Heus C, van der Ploeg TJ, Houdijk APJ. Visceral obesity determined by CT scan and outcomes after colorectal surgery; a systematic review and meta-analysis. Int J Colorectal Dis 2015; 30:875-82. [PMID: 25772271 DOI: 10.1007/s00384-015-2174-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Visceral obesity may affect outcome after colorectal surgery. The visceral fat area as determined by CT scanning is considered the standard in the detection of visceral obesity. METHOD A systematic review was performed of trials investigating the effect of visceral obesity on outcomes of patients with colorectal cancer with no radiotherapy or chemotherapy and measured by CT scanning. The main endpoints were primary hospital stay, morbidity, operative time and blood loss. Quality assessment and data extraction were performed independently by two observers. RESULTS Seven studies were eligible for analysis, including 1230 patients. Primary hospital stay (weighted mean difference 1.16 days, 95% CI 0.0.05 to 2.28 days, p = 0.04), morbidity rates (RR 0.15, 95% CI 0.10 to 0.21, p < 0.00001) and operative time (weighted mean difference 20.47 min, 95% CI 12.76 to 28.17 min, p < 0.00001) were significantly higher for visceral obese patients. No difference was found in blood loss. CONCLUSION Visceral obesity leads to a longer hospital stay, higher morbidity and longer operative time after elective colon surgery. These findings show that the preoperative CT scan for detecting disseminated disease can be used to assess visceral obesity and helps in risk profiling patients undergoing elective colon surgery.
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Affiliation(s)
- Hamit Cakir
- Department of Surgery, Medical Centre Alkmaar, PO 1815 JD, Alkmaar, The Netherlands,
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CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc 2015; 30:1164-71. [PMID: 26123334 DOI: 10.1007/s00464-015-4324-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/11/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The quality of a total mesorectal excision (TME) is one of the most important prognostic factors for local recurrence of rectal carcinoma. The aim of this study was to clarify the manner in which lesser pelvis dimensions affect the quality of TME via the transabdominal approach, while simultaneously defining the criteria for selecting patients most likely to have Grade 3 TME outcomes for a transanal approach using the TaTME technique. METHODS An analysis from the registry was conducted using 93 of total 198 patients with rectal cancer of the mid- and lower third of the rectum who underwent: (1) a low anterior resection, (2) an ultra-low resection with coloanal anastomosis, or (3) an intersphincteric rectal resection, all with total mesorectal excision. The procedures were carried out at the Department of Surgery at the University Hospital Hradec Králové between 2011 and 2014. Rectal specimens were histopathologically examined according to a standardized protocol. Pelvimetry data were obtained using anteroposterior, transverse, and sagittal CT or MRI scans. RESULTS A correlation was found between the quality of the TME and pelvimetry parameter A5, i.e., the angle between the longitudinal axis of the symphysis, and the lines between the symphysis and the promontory (R(2) = -0.327, p < 0.001). The ordinal regression method was used to identify parameters of the model describing levels of probability for TME quality. These relationships were described by equations that provide probability of the achievement of each grade of TME. CONCLUSION The correlation described by obtained equations between pelvimetry parameters and the quality of TME represents a new tool for use in preoperative decision-making with regard to resection via the transanal approach (TaTME).
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Visceral to total obesity ratio and severe hydronephrosis are independently associated with prolonged pneumoperitoneum operative time in patients undergoing laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma. SPRINGERPLUS 2015; 4:290. [PMID: 26120507 PMCID: PMC4478185 DOI: 10.1186/s40064-015-1077-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Our aim was to evaluate the effect of visceral obesity and impact of severe hydronephrosis on surgical complexity in patients undergoing laparoscopic radical nephroureterectomy (LRNU). METHODS From January 2000 to December 2013, 169 patients underwent radical nephroureterectomy at our institution. We retrospectively reviewed the medical records of 70 patients who underwent LRNU. We measured total fat area (TFA) and visceral fat area (VFA) at the level of the umbilicus using computed tomography. We defined accumulated visceral fat distribution as a VFA/TFA ratio ≥0.45. Ipsilateral hydronephrosis was graded from 0 to 4 by two uro-radiologists blinded to the clinical outcomes. RESULTS Among the 70 patients, VFA/TFA ratio was ≥0.45 in 40 patients (57.1%) and 28 (40.0%) had severe hydronephrosis (grade 3 or greater). Patients with a VFA/TFA ratio ≥0.45 had significantly longer pneumoperitoneum and total operation times compared to their counterparts (p = 0.047 and p = 0.002, respectively). Patients with severe hydronephrosis had significantly longer pneumoperitoneum and total operative times compared to their counterparts (p = 0.006 and p = 0.002, respectively). Multivariate logistic regression analysis showed that a high VFA/TFA and severe hydronephrosis were independent predictive factors for prolonged pneumoperitoneum (p = 0.048, HR = 2.90; p = 0.015, HR = 3.82, respectively) and total operative times (p < 0.001, HR = 18.7; p = 0.003, HR = 10.7; respectively). Other pre-clinical factors such as age, gender, BMI, clinical stage, tumor size, location, laterality, degree of perinephric stranding, and surgical procedure did not affect the operation times. CONCLUSION The present data indicated that the visceral type of adipose accumulation and presence of severe hydronephrosis could provide preoperative information on the degree of technical difficulty associated with LRNU.
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Yang T, Wei M, He Y, Deng X, Wang Z. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg 2015; 85:507-13. [PMID: 25902904 DOI: 10.1111/ans.13132] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Tinghan Yang
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Yazhou He
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu Sichuan China
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The role of computed tomography in evaluating body composition and the influence of reduced muscle mass on clinical outcome in abdominal malignancy: a systematic review. Eur J Clin Nutr 2015; 69:1079-86. [PMID: 25782424 DOI: 10.1038/ejcn.2015.32] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/13/2015] [Accepted: 02/02/2015] [Indexed: 12/21/2022]
Abstract
It is estimated that there were 3.45 million new cases and 1.75 million deaths from cancer in Europe in 2012. Colorectal cancer was one of the most common cancers, accounting for 13% of new cases and 12.2% of all deaths. Conditions causing reduced muscle mass, such as sarcopenia, can increase the morbidity and mortality of people with cancer. Computed tomography (CT) scans can provide accurate, high-quality information on body composition, including muscle mass. To date, there has been no systematic review on the role of CT scans in identifying sarcopenia in abdominal cancer. This review aimed to examine the role of CT scans in determining the influence of reduced muscle mass on clinical outcome in abdominal cancer. A systematic review of English-language articles published in 2000 or later was conducted. Articles included cohort, randomised controlled trials and validation studies. Participants were people diagnosed with abdominal cancer who had undergone a CT scan. Data extraction and critical appraisal were undertaken. Ten cohort studies met the inclusion criteria. Seven studies demonstrated that low muscle mass was significantly associated with poor clinical outcome, with six specifically demonstrating reduced survival rates. Eight studies demonstrated that a greater number of patients (27.3-66.7%) were identified as sarcopenic using CT scans compared with numbers identified as malnourished using body mass index. CT scans can identify reduced muscle mass and predict negative cancer outcomes in people with abdominal malignancies, where traditional methods of assessment are less effective.
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Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training Program. Ann Surg 2015; 261:338-44. [PMID: 24646565 DOI: 10.1097/sla.0000000000000651] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The overall aim was to develop and validate a risk prediction score for laparoscopic colorectal surgery training cases. BACKGROUND Published risk prediction scores are not transferable between hospitals because they are derived from a single institution's data and are not designed for use in training situations. METHODS Cases from the prospectively collected database of the National Training Programme in Laparoscopic Colorectal Surgery, between July 2008 and July 2012, were analyzed. Independent risk factors for conversion were identified by the logistic regression. Converting the odds ratios into integers created a risk prediction score for conversion. The clinical impact of this score was investigated by comparing postoperative complications and the level of trainer input in high- and low-risk cases. To study whether adverse outcomes in predicted high-risk cases occur outside the National Training Programme in Laparoscopic Colorectal Surgery, 2 external data sets were examined. RESULTS A total of 2341 cases carried out in 42 hospitals were analyzed. Significant risk factors for conversion were body mass index, American Society of Anesthesiology classification, male sex, prior abdominal surgery, and resection type. At a risk score of more than 6, complication rates increased, including mortality (2.9% vs 0.5%, P < 0.001), anastomotic leak (4.3% vs 1.4%, P = 0.002), and a higher level of trainer input (32.2% vs 19.9% of cases, P < 0.001). Analysis of 786 external cases showed that high-risk cases had higher conversion (18.8% vs 7.1%, P < 0.001), overall complication (36.4% vs 15.0%, P < 0.001), and leak rates (4.0% vs 1.3%, P = 0.015). CONCLUSIONS A risk predication score to facilitate case selection in laparoscopic colorectal surgery training was developed and validated.
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Malietzis G, Aziz O, Bagnall N, Johns N, Fearon K, Jenkins J. The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes: A systematic review. Eur J Surg Oncol 2015; 41:186-96. [DOI: 10.1016/j.ejso.2014.10.056] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/20/2014] [Accepted: 10/23/2014] [Indexed: 01/06/2023] Open
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Clerc D, Blaser B, Demartines N, Christoforidis D. Sagittal abdominal diameter is a better predictor than body mass index for duration of laparoscopic left colectomy. World J Surg 2014; 39:769-75. [PMID: 25413179 DOI: 10.1007/s00268-014-2877-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Visceral obesity (VO) increases technical difficulty in laparoscopic surgery. The body mass index (BMI) does not always correlate to intra-abdominal fat distribution. Our hypothesis was that simple anthropometric measures that reflect VO, could predict technical difficulty in laparoscopic colorectal surgery, as reflected by the operative time, more accurately than the BMI. METHODS Charts of all consecutive patients who underwent laparoscopic left colon resection in our institution between 2007 and 2010 were reviewed retrospectively. On a preoperative CT scan, anthropometric measures were taken on an axial plane at the L4-L5 level. Demographic, operative and anthropometric CT measures were correlated with the operative time. Logistic regression analysis was performed to assess the value of anthropometric CT measures or BMI to predict the duration of the colectomy. RESULTS 121 patients with elective left colon resection for benign (56%) or malignant disease (44%) were included. There were 74 sigmoid resections (61%), 21 left hemicolectomies (17%) and 26 low anterior resections (22%). A longer sagittal abdominal diameter (≥24.8 cm) was significantly associated with longer corrected operative time (248 vs. 228 min, p = 0.043). In multivariate analysis, greater sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter were significantly associated with longer operative time. No significant association was found for the BMI neither in univariate nor in multivariate analysis. CONCLUSIONS This study suggests that simple linear measures taken on a CT scan, such as sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter, may predict longer operative time in laparoscopic left colonic resections more accurately than BMI.
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Affiliation(s)
- Daniel Clerc
- Department of Visceral Surgery, CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland,
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Park BS, Ryu DY, Son GM, Cho YH. Factors influencing on difficulty with laparoscopic total extraperitoneal repair according to learning period. Ann Surg Treat Res 2014; 87:203-8. [PMID: 25317416 PMCID: PMC4196429 DOI: 10.4174/astr.2014.87.4.203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/17/2014] [Accepted: 04/04/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Laparoscopic total extraperitoneal (TEP) repair of inguinal hernia is technically challenging enough to build high barrier to entry. The purpose of this study was to identify clinical factors influencing technical difficulty with laparoscopic TEP according to learning period. METHODS We conducted a retrospective study of 112 adult patients who underwent laparoscopic TEP for unilateral inguinal hernia from January 2009 to September 2013. A technically difficult case was defined as the 70th percentiles or more in the distribution curve of operative time, major complication, or open conversion. RESULTS The rate of body mass index (BMI) above 25 kg/m(2) was significantly higher in the difficult group than the nondifficult group in the learning period of laparoscopic TEP (57.9% vs. 26.8%, respectively, P = 0.020). However, in the experience period, it revealed no statistical difference with technical difficulty (31.3% vs. 33.3%, respectively, P = 0.882). In multivariate analysis, BMI (≥25 kg/m(2)) was identified as a significant independent factor for technical difficulty with laparoscopic TEP in the learning period (odds ratio, 4.572; P = 0.015). CONCLUSION Patient's BMI (≥25 kg/m(2)) can create technical difficulty with laparoscopic TEP only in the learning period, but not in the experience period. Therefore BMI could be applied as one of the guidelines for patient selection, especially for surgeons in the learning curve of laparoscopic TEP.
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Affiliation(s)
- Byung Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Yeon Ryu
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, Ishibe A, Watanabe K, Akiyama H, Ichikawa Y, Morita S, Endo I. The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis 2014; 29:343-51. [PMID: 24297037 DOI: 10.1007/s00384-013-1803-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Although obesity is considered as a risk factor for postoperative morbidity in abdominal surgery, its effect on the outcomes of laparoscopic-assisted colectomy (LAC) is still unclear. The technical difficulty and risk factor for postoperative complication in LAC are thought to be influenced by visceral obesity. The aim of this prospective study was to evaluate the impact of visceral fat on the surgical outcomes of LAC. METHODS Between April 2005 and December 2010, consecutive patients with preoperatively diagnosed colon cancer, excluding medium and low rectal cancer, who underwent LAC, were enrolled. Their visceral fat area (VFA) and body mass index (BMI) were prospectively collected. The VFA was assessed by Fat Scan software. The patients were classified into two groups as follows: VFA nonobese with VFA <100 cm(2) (VNO) and VFA obese with VFA ≧100 cm(2) (VO). The predictive factors for surgical complications of LAC were evaluated by univariate and logistic regression analyses. RESULTS A total of 338 consecutive patients were enrolled in this study. Of the 338 patients, 194 (57.4 %) and 138 (42.6 %) were classified into the VNO and VO groups, respectively. Logistic regression analysis showed that high BMI (≧25 kg/m(2)) and VO independently predicted the incidence of overall postoperative complications (p = 0.040 and 0.007, respectively). VO was more highly related to the incidence of overall postoperative complications, anastomotic leakage (p = 0.021), and surgical site infection (SSI) (p = 0.013) than high BMI. CONCLUSIONS VFA is a more useful parameter than BMI in predicting surgical outcomes after LAC.
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Affiliation(s)
- Jun Watanabe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan,
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Wang C, Xiao Y, Qiu H, Yao J, Pan W. Factors affecting operating time in laparoscopic anterior resection of rectal cancer. World J Surg Oncol 2014; 12:44. [PMID: 24568575 PMCID: PMC3941695 DOI: 10.1186/1477-7819-12-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/10/2014] [Indexed: 02/07/2023] Open
Abstract
Background The objective of this study is to clarify the relationship between demographic and surgical factors and operating time, and thus operative difficulty, in patients undergoing laparoscopic anterior resection for mid-low rectal cancer, since different studies have derived different results. Methods The records of patients with mid-low rectal cancer who underwent laparoscopic anterior resection were retrospectively studied. Demographic data, tumor characteristics, and pelvimetry measurements were collected and analyzed with respect to operating time, using correlation coefficient analysis, principle component analysis, and linear regression. Results A total of 14 patients (10 males, 4 females; 65.50 ± 7.12 years of age) were included. Demographic and tumor characteristics not correlated with operating time. Body mass index (BMI) (P = 0.001); interacetabular distance (IA) (P = 0.001); anatomical transverse distance (IP) (P = 0.008); interischial distance (IS) (P = 0.002); intertuberous distance (IT) (P = 0.005); distance between the coccyx and symphysis (CoSy) (P = 0.013); and the angle of the lower border of the symphysis pubis, upper border of symphysis pubis, and sacral promontory (angle 5) (P = 0.004) were significantly associated with operating time. The equation was: operatingtime=0.653×BMI+0.818×angle5-0.404×IA-0.380×IP-0.512×IS-0.405×IT-0.570×CoSy+330.8. Conclusions Transverse diameters of the pelvis, BMI, angle 5, and CoSy played the most important role in affecting operating time. The equation can be a very useful tool for preoperative assessment.
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Affiliation(s)
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Shuaifuyuan 1, Dongcheng District, Beijing 100730, China.
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Abstract
BACKGROUND Visceral obesity appears to be an emerging parameter affecting postoperative outcome after abdominal surgery. However, total visceral fat remains time consuming to calculate, and there is still a lack of data about its value as an independent risk factor in colorectal surgery. OBJECTIVES The aim of this study was to validate the simple measurement of perirenal fat surface as a surrogate of visceral obesity, and to test the value of perirenal fat surface as a risk factor for morbidity in colorectal surgery and to compare it with the predictive value of other obesity parameters such as BMI and waist-hip ratio. DESIGN This is a prospective observational cohort study. SETTING The study was conducted at a tertiary university hospital. PATIENTS Two hundred twenty-four consecutive patients (130 male) undergoing elective colorectal surgery with a mean age of 65.2 years (SD, ±12.9) were identified. INTERVENTION Elective colorectal resections were performed. MAIN OUTCOME MEASURES We assessed complications as the primary outcome measure. Secondary outcome measures were the conversion rates, duration of operation, and length of hospital stay. RESULTS Perirenal fat surface was validated as a surrogate of visceral fat and a strong correlation between the 2 was confirmed (Spearman correlation coefficient ρ = 0.96). The overall postoperative complication rate was 22.8% (51/224) with 14.7% moderate complications (grade I and II) and 7.6% severe complications (grade III-IV), with a mortality rate of 0.5%. Multivariate analysis confirmed perirenal fat surface as an independent risk factor for postoperative complications (OR, 3.87; 95% CI, 1.73-8.64; p = 0.001), whereas BMI and waist-hip ratio were not statistically associated with postoperative complications (OR, 1.16; 95% CI, 0.51-2.66; p = 0.72). LIMITATIONS This study was limited by its sample size. CONCLUSION Perirenal fat surface is an excellent and easy-to-reproduce indicator of visceral fat volume. Furthermore, perirenal fat surface is an independent risk factor for postoperative outcome in colorectal surgery that appears to be of higher predictive value than BMI and waist-hip ratio.
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