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Alharbi R, Almosallam O, Albastaki S, Almughamsi A, Alsanea N. Role of body mass index in anastomotic leakage after curative treatment for rectal cancer. Ann Saudi Med 2024; 44:135-140. [PMID: 38853477 PMCID: PMC11268469 DOI: 10.5144/0256-4947.2024.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/23/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Anastomotic leakage (AL) represents a severe complication after rectal surgery, leading to significant morbidity, mortality, and increased healthcare costs. Despite improvements in surgical methods and perioperative care, the challenge of AL persists. OBJECTIVES Explore the impact of body mass index (BMI) on the risk of AL following curative treatment for rectal cancer, providing insight into its predictive value. DESIGN Retrospective review. SETTINGS Data were collected from a single tertiary center, emphasizing the specialized postoperative outcomes in a high-care setting. PATIENTS AND METHODS The study population was comprised patients who underwent sphincter-saving surgery combined with neoadjuvant chemoradiation for rectal cancer from 2001 to 2011. Patients with anastomotic stenosis were excluded. MAIN OUTCOME MEASURES The primary outcome investigated was the occurrence of AL post-surgery. Secondary outcomes included the assessment of local cancer recurrence rates within the AL group. SAMPLE SIZE 224; 13 excluded. RESULTS Of 237 patients who underwent surgery, 13 with anastomotic stenosis were excluded from this study. Of the remaining 224, 15 individuals (6.3%) developed AL. A potential association between higher BMI and increased AL risk was identified. Additionally, the study noted a higher incidence of local rectal cancer recurrence in the group that developed leakage. CONCLUSION The findings suggest BMI as a significant predictive factor for AL after curative rectal cancer treatment. This emphasizes the need for heightened awareness and possible preoperative counseling for obese patients regarding their increased risk of postoperative leakage. LIMITATIONS The study was retrospective with all the inherit biases of such studies. The sample size was small and this may have introduced a type 2 statistical error.
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Affiliation(s)
- Reem Alharbi
- From the Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Osama Almosallam
- From the Department of Pediatric Surgery, King Abdullah Specialist Children Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sara Albastaki
- From the Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Asim Almughamsi
- From the College of Medicine - Taibah University, Saudi Arabia
| | - Nasser Alsanea
- From the Director General, Health Affairs, Princess Nourah Bint Abdulrahhman University, Saudi Arabia
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Yanagi M, Hamasaki T, Katsu A, Kono H, Kimata R, Nishimura T, Kondo Y. Usefulness of hand-assisted retroperitoneal laparoscopic radical nephrectomy for extreme obese patients -a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:187-190. [PMID: 38735720 DOI: 10.2152/jmi.71.187] [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: 05/14/2024]
Abstract
We report a case of retroperitoneal laparoscopic radical nephrectomy (LRN) in which the addition of a hand port was necessary and effective. A 52-year-old man with obesity (BMI 40.6 kg/m2) was diagnosed with a 52-mm left renal cell carcinoma (cT1bN0M0). To avoid thick subcutaneous and visceral fat in the abdomen, we selected LRN using a retroperitoneal approach with four ports in the kidney position. During surgery, a large amount of flank pad and perirenal fat prevented us from securing a sufficient surgical field through traction of the kidney with a retractor. A pure laparoscopic procedure was not feasible;therefore, we added a hand port. Subsequently, we removed the flank pad from the hand port and secured the surgical field by tracing the kidney manually. Finally, hand-assisted LRN was completed without an open conversion. In retroperitoneal LRN, we rarely encounter patients for whom a pure laparoscopic procedure is not feasible because of the large amount of flank pad or perirenal fat. It is important to preoperatively confirm not only the BMI but also the amount of flank pad and perirenal fat on imaging. Hand-assisted LRN via the retroperitoneal approach can be safely performed even in extremely obese patients. J. Med. Invest. 71 : 187-190, February, 2024.
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Affiliation(s)
- Masato Yanagi
- Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Akifumi Katsu
- Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Hiroyoshi Kono
- Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Ryoji Kimata
- Department of Urology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Taiji Nishimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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Cui B, Chen Y, Chen X, Wang T, Wang L, Liu F, Ouyang Q, Zhang X, Gao Y, Ma X. Impact of Visceral Fat Area on Intraoperative Complexity and Surgical Approach Decision for Robot-Assisted Partial Nephrectomy: A Comparative Analysis with BMI. Med Sci Monit 2023; 29:e941953. [PMID: 37919887 PMCID: PMC10629268 DOI: 10.12659/msm.941953] [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] [Received: 07/27/2023] [Accepted: 09/02/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Optimizing surgical approaches for robot-assisted partial nephrectomy (RAPN) is vital for better patient outcomes. This retrospective study aimed to examine how visceral fat area (VFA) and body mass index (BMI) correlate with intraoperative complexities, thereby guiding the selection of surgical techniques for RAPN. MATERIAL AND METHODS The study analyzed the medical records of 213 Chinese patients diagnosed with a range of benign and malignant renal neoplasms and treated with RAPN in 2020. Visceral fat area was quantified using computed tomography (CT) scans taken at the umbilical level. Various perioperative indicators, such as demographic details, clinicopathological parameters, operation time, estimated blood loss (EBL), warm ischemic time (WIT), and intraoperative complications, were assessed. RESULTS For the retroperitoneal approach, patients with either visceral obesity or general obesity had longer operation times (P<0.001 and P=0.004) and had a tendency for higher EBL (P=0.003 and P=0.001) compared to non-obese patients. In the transperitoneal approach, those with visceral obesity had significantly longer operation times (P=0.008) than their non-viscerally obese counterparts; however, general obesity showed no impact on operation time (P=0.251). Estimated blood loss was higher for patients with visceral obesity (P=0.004), but no significant difference was noted among those with general obesity (P=0.980). CONCLUSIONS VFA appears to offer predictive advantages over BMI in assessing intraoperative complexities for transperitoneal RAPN. When used in conjunction with BMI, it could serve as a valuable tool in selecting the most appropriate surgical approach for RAPN.
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Affiliation(s)
- Bo Cui
- Medical School of Chinese PLA, Beijing, PR China
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Yulan Chen
- Medical School of Chinese PLA, Beijing, PR China
| | - Xinran Chen
- Medical School of Chinese PLA, Beijing, PR China
| | - Tao Wang
- Medical School of Chinese PLA, Beijing, PR China
| | - Li Wang
- Medical School of Chinese PLA, Beijing, PR China
| | - Fan Liu
- Medical School of Chinese PLA, Beijing, PR China
| | - Qing Ouyang
- Medical School of Chinese PLA, Beijing, PR China
| | - Xiangyi Zhang
- School of Medicine, Nankai University, Tianjin, PR China
| | - Yu Gao
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, PR China
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Wong DL, Holland A, Kocak M, Coday M, Brown C, Monroe JJ, Hinkle NM, Deneve JL, Glazer ES, Shibata D. The Impact of an Enhanced Recovery Protocol in a High-Risk Population Undergoing Colon Cancer Surgery. Am Surg 2023; 89:4485-4495. [PMID: 35969481 DOI: 10.1177/00031348221121540] [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: 11/16/2022]
Abstract
OBJECTIVE Enhanced Recovery ERP protocols (ERP) have improved surgical outcomes in patients undergoing elective colon cancer (CC) surgery; however, efficacy in different populations may vary. We examined the impact of an ERP in a population with high rates of obesity and multiple comorbidities. METHODS We performed a retrospective analysis of factors associated with postoperative complications (PoC) and length of stay (LOS) following CC surgery from 2011 to 2019 in a 5-hospital healthcare system which serves a population with higher rates of obesity (body mass index ≥30kg/m2) and multi-comorbidities, as compared to published studies. Univariable and multivariable analyses were performed. RESULTS A total of 408 elective CC surgery patients with complete oncologic surgical data were identified. Of these, 191 (46.81%) were under ERP. Factors independently associated with PoC included obesity (OR=1.66, P=.029), laparoscopic (OR=.52, P=.020), and hybrid (OR=.38, P=.012) versus open surgery and ASA (American Society of Anesthesiologists) class ≥3 (OR=1.98, P=.006). ERP did not impact PoC but was associated with a reduction in LOS (β=-1.02 days, 95%CI: -1.75 - -.30, P=.006). ERP had an impact on LOS in both the non-obese and obese groups (P<.001 and P=.034, respectively). PoC significantly increased LOS (β=6.67 days, 95%CI: 5.41-7.03, P<.001). CONCLUSIONS Following elective CC surgery, obesity and medical comorbidities were associated with increased PoC and in turn, as expected, increased LOS. ERP was associated with a reduction in LOS in both obese and non-obese patients. In high-risk populations, application of ERP may be particularly important to optimize surgical outcomes following CC surgery.
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Affiliation(s)
- Denise L Wong
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis Holland
- Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | - Mehmet Kocak
- Istanbul Medipol University, International School of Medicine, Istanbul, Turkey
| | - Mace Coday
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Caroline Brown
- Prisma Health/University of South Carolina, Greenville, SC, USA
| | - Justin J Monroe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathan M Hinkle
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Feng Z, Pang K, Tian M, Gu X, Lin H, Yang X, Yang Y, Zhang Z. Sarcobesity, but not visceral fat, is an independent risk factor for complications after radical resection of colorectal cancer. Front Nutr 2023; 10:1126127. [PMID: 37260520 PMCID: PMC10228740 DOI: 10.3389/fnut.2023.1126127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/10/2023] [Indexed: 06/02/2023] Open
Abstract
Background The influence of body composition on the outcome of colorectal cancer surgery is controversial. The aim of this study was to evaluate the effects of visceral obesity and sarcobesity on the incidence of total and surgical complications after radical resection of colorectal cancer. Methods We collected a total of 426 patients who underwent elective radical resection of colorectal cancer at Beijing Friendship Hospital, Capital Medical University from January 2017 to May 2018. According to the inclusion and exclusion criteria, 387 patients were finally included. A CT scan at the level of the L3-L4 intervertebral disk was selected to measure the values of visceral fat area and skeletal muscle area. Multivariate analysis was used to explore the independent risk/protective factors affecting postoperative complications. Results 128 (33.1%) patients developed complications, and 44 (11.4%) patients developed major complications. Among them, 111 patients developed surgical complications and 21 developed medical complications. Visceral fat area (Z = -3.271, p = 0.001), total fat area (Z = -2.613, p = 0.009), visceral fat area to subcutaneous fat area ratio (V/S, Z = -2.633, p = 0.008), and sarcobesity index (Z = -2.282, p = 0.023) were significantly associated with total complications. Visceral fat area (Z = -2.119, p = 0.034) and V/S (Z = -2.010, p = 0.044) were significantly associated with total surgical complications. Sarcobesity index, smoking, stoma, blood loss, surgery time, and American Society of Anesthesiology (ASA) score were selected as risk factors for total postoperative complications according to LASSO regression. Multivariate logistic regression analysis suggested that sarcobesity index was an independent risk factor for postoperative total complications and surgical complications. Subgroup analysis suggested that albumin level was an independent protective factor for postoperative total complications in male patients. Smoking, operative time, and sarcobesity index were independent risk factors, and cholesterol was an independent protective factor for total postoperative complications in female patients. Conclusion Increased sarcobesity index is an independent risk factor for postoperative complications in patients with colorectal cancer, while visceral fat area is not. For female patients, smoking, operation time, and obesity index are independent risk factors for postoperative complications, while cholesterol is an independent protective factor. For male patients, serum albumin is an independent protective factor for postoperative complications.
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Han L, Deng C, Zhao R, Wan Q, Zhang X, Wang X, Chen Y. Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery. Front Endocrinol (Lausanne) 2023; 14:1072540. [PMID: 36843597 PMCID: PMC9947141 DOI: 10.3389/fendo.2023.1072540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Few studies have investigated the correlation between visceral fat area (VFA) and early postoperative complications in patients with obesity undergoing bariatric surgery. This study aimed to investigate the relationship between VFA and early postoperative complications in patients with obesity following bariatric surgery. METHODS The study was conducted at a tertiary university hospital. Patients with obesity who underwent laparoscopic sleeve gastrectomy between June 2016 and October 2020 were divided into two groups based on umbilical level VFA: high-VFA group (umbilical level VFA ≥ 100 cm2) and low-VFA group (umbilical level VFA < 100 cm2). Baseline characteristics, intraoperative and postoperative conditions, and early postoperative complications were compared between the groups. The primary outcome was early postoperative complications, and the secondary outcome was postoperative hospital stay. RESULTS The study included 152 patients, with 82 patients in the low-VFA group and 70 patients in the high-VFA group. The high-VFA group had a higher incidence of early postoperative complications (14.29% vs. 2.44%, P = 0.013) than the low-VFA group. The length of postoperative hospital stay did not differ significantly between the groups. CONCLUSIONS Our study suggests that excess VFA is an independent risk factor for early postoperative complications following bariatric surgery, and VFA may be used in preoperative evaluations.
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Affiliation(s)
- Liping Han
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyi Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qianyi Wan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofang Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiao Wang, ; Yi Chen,
| | - Yi Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiao Wang, ; Yi Chen,
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García-Martínez S, González-Gamo D, Tesolato SE, Barabash A, de la Serna SC, Domínguez-Serrano I, Dziakova J, Rivera D, Torres AJ, Iniesta P. Telomere Length and Telomerase Activity in Subcutaneous and Visceral Adipose Tissues from Obese and Non-Obese Patients with and without Colorectal Cancer. Cancers (Basel) 2022; 15:cancers15010273. [PMID: 36612269 PMCID: PMC9818289 DOI: 10.3390/cancers15010273] [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: 11/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
To investigate the molecular mechanisms that link obesity and colorectal cancer (CRC), we analyzed parameters related to telomere function in subcutaneous and visceral adipose tissues (SAT and VAT), including subjects with and without CRC, who were classified according to their body mass index (BMI). Adipose tissues were obtained from 147 patients who had undergone surgery. A total of 66 cases corresponded to CRC patients, and 81 subjects were not affected by cancer. Relative telomere length was established by qPCR, and telomerase activity was determined by a method based on the telomeric repeat amplification protocol. Our results indicated longer telomeres in patients affected by CRC, both in SAT and VAT, when compared to the group of subjects without CRC. Tumor local invasion was associated with telomere length (TL) in SAT. Considering the BMI values, significant differences were found in the TL of both adipose tissues between subjects affected by CRC and those without cancer. Overweight subjects showed the greatest differences, with longer telomeres in the group of CRC patients, and a higher number of cases with telomerase reactivation in the VAT of subjects without cancer. In conclusion, parameters related to telomere function in adipose tissue could be considered as potential biomarkers in the evaluation of CRC and obesity.
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Affiliation(s)
- Sergio García-Martínez
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain
| | - Daniel González-Gamo
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain
| | - Sofía Elena Tesolato
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
| | - Ana Barabash
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- CIBERDEM (Network Biomedical Research Center for Diabetes and Associated Metabolic Diseases), Carlos III Institute of Health, 28029 Madrid, Spain
- Endocrinology & Nutrition Service, San Carlos Hospital, 28040 Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, 28040 Madrid, Spain
| | - Sofía Cristina de la Serna
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Digestive Surgery Service, San Carlos Hospital, 28040 Madrid, Spain
| | - Inmaculada Domínguez-Serrano
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Digestive Surgery Service, San Carlos Hospital, 28040 Madrid, Spain
| | - Jana Dziakova
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Digestive Surgery Service, San Carlos Hospital, 28040 Madrid, Spain
| | - Daniel Rivera
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Digestive Surgery Service, San Carlos Hospital, 28040 Madrid, Spain
| | - Antonio José Torres
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Digestive Surgery Service, San Carlos Hospital, 28040 Madrid, Spain
| | - Pilar Iniesta
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040 Madrid, Spain
- Sanitary Research Institute of San Carlos Hospital (IdISSC), 28040 Madrid, Spain
- Correspondence:
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Gigic B, van Roekel E, Holowatyj AN, Brezina S, Geijsen AJMR, Ulvik A, Ose J, Koole JL, Damerell V, Kiblawi R, Gumpenberger T, Lin T, Kvalheim G, Koelsch T, Kok DE, van Duijnhoven FJ, Bours MJ, Baierl A, Li CI, Grady W, Vickers K, Habermann N, Schneider M, Kampman E, Ueland PM, Ulrich A, Weijenberg M, Gsur A, Ulrich C. Cohort profile: Biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer recurrence and survival - the FOCUS Consortium. BMJ Open 2022; 12:e062930. [PMID: 36549742 PMCID: PMC9772678 DOI: 10.1136/bmjopen-2022-062930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The overarching goal of the FOCUS (biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer (CRC) recurrence and survival) Consortium is to unravel the effect of folate and folate-mediated one-carbon metabolism (FOCM) biomarkers on CRC prognosis to provide clinically relevant advice on folate intake to cancer patients and define future tertiary prevention strategies. PARTICIPANTS The FOCUS Consortium is an international, prospective cohort of 2401 women and men above 18 years of age who were diagnosed with a primary invasive non-metastatic (stages I-III) CRC. The consortium comprises patients from Austria, two sites from the Netherlands, Germany and two sites from the USA. Patients are recruited after CRC diagnosis and followed at 6 and 12 months after enrolment. At each time point, sociodemographic data, data on health behaviour and clinical data are collected, blood samples are drawn. FINDINGS TO DATE An increased risk of cancer recurrences was observed among patients with higher compared with lower circulating folic acid concentrations. Furthermore, specific folate species within the FOCM pathway were associated with both inflammation and angiogenesis pathways among patients with CRC. In addition, higher vitamin B6 status was associated with better quality of life at 6 months post-treatment. FUTURE PLANS Better insights into the research on associations between folate and FOCM biomarkers and clinical outcomes in patients with CRC will facilitate the development of guidelines regarding folate intake in order to provide clinically relevant advice to patients with cancer, health professionals involved in patient care, and ultimately further tertiary prevention strategies in the future. The FOCUS Consortium offers an excellent infrastructure for short-term and long-term research projects and for combining additional biomarkers and data resulting from the individual cohorts within the next years, for example, microbiome data, omics and multiomics data or CT-quantified body composition data.
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Affiliation(s)
- Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Eline van Roekel
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreana N Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Janna L Koole
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Victoria Damerell
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Torsten Koelsch
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Franzel J van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Martijn J Bours
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Wien, Austria
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - William Grady
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathy Vickers
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Surgical Department I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Matty Weijenberg
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Gsur
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Cornelia Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Impact of atherosclerosis on the postoperative complications of colorectal surgery in older patients with colorectal cancer. BMC Gastroenterol 2022; 22:519. [PMID: 36513977 DOI: 10.1186/s12876-022-02600-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Atherosclerosis is associated with various comorbidities; nonetheless, its effect on the postoperative complications of colorectal surgery in older patients with colorectal cancer (CRC) remains unclear. This study aimed to evaluate the impact of atherosclerosis on the postoperative complications of colorectal surgery in older adults with CRC. METHODS Patients aged ≥ 65 years who underwent surgery for CRC between April 2017 and October 2020 were enrolled. To evaluate atherosclerosis, we prospectively calculated the cardio-ankle vascular index (CAVI) measured by the blood pressure/pulse wave test and abdominal aortic calcification (AAC) score from computed tomography. Risk factors for Clavien-Dindo grade ≥ III postoperative complications were evaluated by univariate and logistic regression analyses. RESULTS Overall, 124 patients were included. The mean CAVI value and AAC score were 9.5 ± 1.8 and 7.0 ± 8.0, respectively. Clavien-Dindo grade ≥ III postoperative complications were observed in 14 patients (11.3%). CAVI (odds ratio, 1.522 [95% confidence interval, 1.073-2.160], p = 0.019), AAC score (1.083 [1.009-1.163], p = 0.026); and operative time (1.007 [1.003-1.012], p = 0.001) were identified as risk factors for postoperative complications. Based on the optimal cut-off values of CAVI and AAC score, the probability of postoperative complications was 27.8% in patients with abnormal values for both parameters, which was 17.4 times higher than the 1.6% probability of postoperative complications in patients with normal values. CONCLUSIONS Atherosclerosis, particularly that assessed using CAVI and AAC score, could be a significant predictor of postoperative complications of colorectal surgery in older adults with CRC.
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Guo H, Zhang Y, Ma H, Gong P, Shi Y, Zhao W, Wang A, Liu M, Sun Z, Wang F, Wang Q, Ba X. T-stage-specific abdominal visceral fat, haematological nutrition indicators and inflammation as prognostic factors in patients with clear renal cell carcinoma. Adipocyte 2022; 11:133-142. [PMID: 35285399 PMCID: PMC8920171 DOI: 10.1080/21623945.2022.2048546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Clear cell renal carcinoma (ccRCC) is the most common histological type of renal cancer and has the highest mortality. Several studies have been conducted on the relationship between adipose tissue and ccRCC prognosis, however, the results have been inconsistent to date. The current study aimed at establishing a link between abdominal fat composition and short-term prognosis in patients with ccRCC after T-stage stratification. We retrospectively analysed 250 patients with pathologically confirmed ccRCC (173 low T-stage and 77 high T-stage) in our hospital. The computed tomography (CT) images were evaluated using ImageJ. Then, subcutaneous and visceral fat areas (SFA and VFA), total fat areas (TFA) and the relative VFA (rVFA) were measured and computed. Meanwhile, biochemical indices of blood serum were analysed. The results showed that rVFA in low T-stage cohort who had a history of short-term postoperative complications were significantly lower than those who did not. No such association was observed in the high T-stage cohort. Further investigation revealed that the correlations between biochemical indexes and fat area-related variables varied across T-stage groups. As a result, rVFA is a reliable independent predictor of short-term prognosis in patients with low T-stage ccRCC but not in patients with high T-stage ccRCC.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Yumei Zhang
- Department of Radiology, Lanshan Branch of Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Peiyou Gong
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Wenlei Zhao
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Aijie Wang
- Department of Radiology, Yaitai Shan Hospital, Shandong province, Yantai, China
| | - Ming Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Zehua Sun
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Shandong province, Yantai, China
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11
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Gao B, Li X, Chen W, Wang S, He J, Liu Y, Ding C, Chen X. The associations between lipid profiles and visceral obesity among gastrointestinal cancer patients: a cross-sectional study. Lipids Health Dis 2022; 21:102. [PMID: 36242019 PMCID: PMC9563782 DOI: 10.1186/s12944-022-01707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Visceral obesity is associated with cancer incidence and prognosis. Altered lipid profiles are frequently seen in visceral obese patients. The blood test of lipid profiles is more convenient and has no radical side effects than computed tomography (CT), which is presently the most accurate way to measure visceral fat area. This article aims to investigate the associations between lipid profiles and visceral obesity in gastrointestinal cancer patients. Methods In total, 399 patients newly diagnosed with gastrointestinal cancer were enrolled in this observational study. Lipid profiles were obtained from blood samples, and visceral fat mass area (VFA) was measured by CT. VFA ≥ 100 cm2 was considered visceral obesity. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate the prognostic powers of lipid parameters for viscerally obese gastrointestinal cancer patients. Results Patients who had visceral obesity had higher triglyceride (TG) levels (1.20 ± 0.60 vs. 0.87 ± 0.57 mmo/L, P < 0.001), total cholesterol (TC) levels (3.57 ± 0.84 vs. 3.40 ± 0.82, P = 0.044), and low-density lipoprotein (LDL-C) levels (2.08 ± 0.66 vs. 1.94 ± 0.66, P = 0.047) and lower high-density lipoprotein (HDL-C) levels (0.88 ± 0.24 vs. 1.00 ± 0.26, P < 0.001) than those in the normal group. TG was positively correlated with VFA (r = 0.299, P < 0.001), while HDL-C was inversely correlated with VFA (r = -0.237, P < 0.001). TG and HDL-C had predictive capacity for visceral obesity at cutoff levels of 0.92 mmol/L (AUROC 0.700, 95% CI, 0.653–0.745, P < 0.001) and 0.98 mmol/L (AUROC 0.700, 95% CI, 0.585–0.682, P < 0.001), respectively. TG > 0.92 mmol/L with HDL-C < 0.98 mmol/L was linked with an increased risk of visceral obesity (OR = 4.068, 95% CI, 2.338—7.079, P < 0.001). Conclusions Lipid profiles were significantly correlated with VFA. Gastrointestinal cancer patients with TG > 0.92 mmol/L and HDL-C < 0.98 mmol/L were at elevated risk of visceral obesity in the Chinese population. Identifying visceral obesity and taking proper actions in gastrointestinal cancers are helpful for overall tumor prognosis.
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Affiliation(s)
- Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Xiangrui Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Shu'an Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 1 Tianfei Road, Qinhuai District, Nanjing, China
| | - Chao Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China.
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China.
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12
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Wang Y, Wang Y, Ai L, Zhang H, Li G, Wang Z, Jiang X, Yan G, Liu Y, Wang C, Xiong H, Wang G, Liu M. Linear Skeletal Muscle Index and Muscle Attenuation May Be New Prognostic Factors in Colorectal Carcinoma Treated by Radical Resection. Front Oncol 2022; 12:839899. [PMID: 35280815 PMCID: PMC8904745 DOI: 10.3389/fonc.2022.839899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study evaluated the association between body composition and clinical parameters and prognosis in patients with colorectal cancer (CRC) treated by radical resection. Methods Baseline data on patient age, body mass index (BMI), bowel obstruction and tumor-related factors were collected retrospectively. Body composition parameters such as visceral fat area (VFA), total abdominal muscle area (TAMA), muscle attenuation (MA), posterior renal fat thickness (PPNF) and intermuscular fat area (IMF) are measured using Computed tomography (CT) scans. We also propose a new predictor of linear skeletal muscle index (LSMI) that can be easily measured clinically at CT. Follow-up endpoints were disease-free survival and all-cause death. We follow up with patients in hospital or by telephone. Univariate and multifactorial Cox proportional hazards analyses were performed to identify risk factors associated with prognosis. Survival analysis was performed using the Kaplan-Meier method and a nomogram was established to predict survival. Results A total of 1761 patients (median age 62 years) with CRC were enrolled in our study, of whom 201 had intestinal obstruction and 673 had a BMI > 24.0. Among all patients, the 3- and 5-year disease-free survival rates were 84.55% and 68.60% respectively, and the overall survival rates were 88.87% and 76.38%. Overall survival was significantly correlated with MA, LSMI, SMI, Tumor size, N stage, metastasis and adjuvant therapy by Cox regression analysis (p < 0.05). The risk of tumor progression was significantly associated with MA, VFA, LSMI, SMI, Male, N stage, metastasis and adjuvant therapy (p < 0.05). In addition, based on the Chinese population, we found that female patients with MA < 30.0 HU, LSMI < 18.2, and SMI < 38.0 had a worse prognosis, male patients with MA < 37.6 HU, LSMI < 21.9, and SMI < 40.3 had a poorer prognosis. Conclusion Our findings suggest that linear skeletal muscle index and MA can be used as new independent predictors for colorectal cancer patients treated with radical surgery, and that baseline data such as body composition parameters, LSMI and tumor-related factors can collectively predict patient prognosis. These results could help us to optimize the management and treatment of patients after surgery.
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Affiliation(s)
- Yang Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuliuming Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lianjie Ai
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hao Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guodong Li
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zitong Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Jiang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoqing Yan
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yunxiao Liu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunlin Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huan Xiong
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyu Wang
- Department of Colorectal Surgery, Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China
| | - Ming Liu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Saeki T, Otowa Y, Yamazaki Y, Arai K, Shimizu T, Mii Y, Kakinoki K, Oka S, Nakamura T, Kuroda D. Distance of Peritoneum to Inferior Mesenteric Artery Predicts the Operation Time During Laparoscopic Colectomy for Sigmoid or Rectosigmoid Colon Cancer. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:240-246. [PMID: 35399172 PMCID: PMC8962805 DOI: 10.21873/cdp.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Obesity is a major technical limiting factor for laparoscopic surgery because abundant visceral fat is known to extend the operation time. However, special hardware is needed to assess it. We hypothesized that the depth from the peritoneum to the bifurcation of the inferior mesenteric artery (IMA) defined as 'peritoneum to IMA distance (PID)' might be a simple predictive factor for extended operation time during laparoscopic colectomy. PATIENTS AND METHODS One hundred twenty-four patients who were diagnosed with sigmoid or rectosigmoid colon cancer and underwent laparoscopic colectomy were included. The patients were divided into two groups based on the operation time (210 min). The vertical distance from the peritoneum to the bifurcation of the inferior mesenteric artery was defined as PID. The factors eliciting an operation time longer than 210 min were investigated. RESULTS There was significant difference in sex, BMI, cT, cN, and PID between the Early group (<210 min) and Late group (≥210 min). Less blood loss was observed in the Early group than in the Late group. Multivariate analysis showed that PID was the only independent factor that affected operation time (p<0.001). CONCLUSION PID predicts the operation time during laparoscopic colectomy for sigmoid or rectosigmoid colon cancer.
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Affiliation(s)
- Takafumi Saeki
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yasunori Otowa
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yuta Yamazaki
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Keisuke Arai
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Takashi Shimizu
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Yasuhiko Mii
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | | | - Shigeteru Oka
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Tetsu Nakamura
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
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14
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Body Composition Predictors of Adverse Postoperative Events in Patients Undergoing Surgery for Long Bone Metastases. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202203000-00010. [PMID: 35262530 PMCID: PMC8913089 DOI: 10.5435/jaaosglobal-d-22-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022]
Abstract
Body composition assessed using opportunistic CT has been recently identified as a predictor of outcome in patients with cancer. The purpose of this study was to determine whether the cross-sectional area (CSA) and the attenuation of abdominal subcutaneous adipose tissue, visceral adipose tissue (VAT), and paraspinous and abdominal muscles are the predictors of length of hospital stay, 30-day postoperative complications, and revision surgery in patients treated for long bone metastases.
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15
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Koh W, Lee CS, Bae JH, Al-Sawat A, Lee IK, Jin HY. Clinical validation of implementing Enhanced Recovery After Surgery protocol in elderly colorectal cancer patients. Ann Coloproctol 2022; 38:47-52. [PMID: 34284558 PMCID: PMC8898633 DOI: 10.3393/ac.2021.00283.0040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/01/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the safety and feasibility of applying enhanced recovery after surgery (ERAS) protocol in elderly colorectal cancer patients. METHODS The medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups. RESULTS In total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P=0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0±13.2 vs. OG, 11.7±23.0; P=0.130). In regression analysis, old age (>70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients. CONCLUSION Implementing the ERAS protocol in patients aged >70 years is safe and feasible. High CRP (≥6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.
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Affiliation(s)
- Wooree Koh
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Abdullah Al-Sawat
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeong Yong Jin
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Springer JE, Beauharnais C, Chicarilli D, Coderre D, Crawford A, Baima JA, McIntosh LJ, Davids JS, Sturrock PR, Maykel JA, Alavi K. S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer. Surg Endosc 2022; 36:5408-5415. [PMID: 34988741 DOI: 10.1007/s00464-021-08872-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Malnutrition and deconditioning impact postoperative morbidity and mortality. Computed tomography (CT) body composition variables are used as markers of nutritional status and sarcopenia. The objective of this study is to evaluate the impact of sarcopenia, using CT variables, on postoperative outcomes following transanal total mesorectal excision (TaTME) for rectal cancer. METHODS This was an institutional retrospective cohort analysis of consecutive rectal cancer patients who underwent TaTME between April 2014 and May 2020. Psoas muscle index (PMI) was calculated from diagnostic CT scans. Based on previous studies, patients in the lowest PMI tertile by gender were considered sarcopenic. Fisher's exact and Mann-Whitney U test were used to compare categorical and continuous variables, respectively. Readmission rates and postoperative complications were compared between groups. Backward stepwise logistic regression was used to determine the association between sarcopenia and 30-day postoperative complications. RESULTS 85 patients were analyzed, of which 63% were male, with a median age of 59 (IQR: 51-65), and median BMI of 28 (IQR: 24-32). Of the entire cohort, 34% (n = 29) were sarcopenic (median PMI 5.39 IQR: 4.49-6.71). No significant difference in baseline characteristics between sarcopenic and nonsarcopenic patients were observed. 55% of sarcopenic patients experienced a complication within 30 days compared to 24% of nonsarcopenic patients (p = 0.01). 41% of sarcopenic patients required hospital readmission within 30 days compared to 17% of their nonsarcopenic counterparts (p = 0.014). Sarcopenic patients also experienced significantly higher rates of post-operative small bowel obstruction (10% vs. 0%, p = 0.04). Multivariable analyses identified that sarcopenic patients have a fourfold increase in odds of experiencing a 30-day postoperative complication (OR: 4.44, 95%CI: 1.6-12.4, p < 0.05) after adjusting for gender. CONCLUSION Preoperative sarcopenia is associated with increased 30-day postoperative complications following TaTME for rectal cancer. Postoperative complications can have serious oncologic implications by delaying adjuvant chemotherapy. Therefore, preoperative recognition of sarcopenia prior to undergoing TaTME for rectal cancer may provide an opportunity for early intervention with prehabilitation programs.
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Affiliation(s)
- Jeremy E Springer
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Catherine Beauharnais
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Derek Chicarilli
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Danielle Coderre
- Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Allison Crawford
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Jennifer A Baima
- Department of Orthopedic Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lacey J McIntosh
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Davids
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Paul R Sturrock
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Justin A Maykel
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA
| | - Karim Alavi
- Colorectal Division, Department of Surgery, University of Massachusetts Medical School, 67 Belmont Suite 201, Worcester, MA, 01605, USA.
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Hara T, Kogure E, Iijima S, Fukawa Y, Kubo A, Kakuda W. Preoperative Walking Capacity Indirectly Relates to Decreased Postoperative Complications in Patients with Gastrointestinal Cancer. Prog Rehabil Med 2022; 7:20220002. [PMID: 35118212 PMCID: PMC8784540 DOI: 10.2490/prm.20220002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/28/2021] [Indexed: 02/03/2023] Open
Abstract
Objectives: Postoperative complications (PCs) in patients with gastrointestinal cancer (GIC) lead
to reduced lifespan and poor quality of life. The aim of this study was to investigate
the correlation between preoperative exercise-related factors, together with other
contributory factors, and the frequency of PCs in patients with GIC. Methods: This was a cross-sectional, three-institution study. We enrolled 299 patients who were
scheduled for elective surgery for GIC (182 men and 117 women; age, 65.7 ± 11.0 years).
PCs were graded using the Clavien–Dindo classification based on the medical records 1
month postoperatively. Exercise-related factors (the skeletal muscle index, the
isometric knee extension torque, and the 6-min walk test [6 MWT] distance) were measured
before surgery. Based on previous studies of factors contributing to complications, data
on age, sex, clinical cancer stage, comorbidities, neoadjuvant therapy, type of surgery,
surgery duration, blood loss, blood transfusion, laboratory data, respiratory function,
body mass index, and visceral fat area were collected. Results: The frequency of PCs was positively correlated with surgery duration (β=0.427) and
C-reactive protein (CRP) level on postoperative day 3 (β=0.189). The 6 MWT was
negatively correlated with the frequency of PCs through CRP level on postoperative day 3
(β=–0.035). This model demonstrated an acceptable fit to the data (goodness-of-fit
index, 0.979; adjusted goodness-of-fit index, 0.936; comparative fit index, 0.944; and
root mean square error of approximation, 0.076). Conclusions: Preoperative walking capacity was correlated with PCs in patients undergoing GIC
surgery. Prevention of PCs in patients with GIC requires the monitoring of both surgical
parameters and postoperative inflammation.
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Affiliation(s)
- Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Eisuke Kogure
- Rehabilitation Progress Center Incorporated, Tokyo, Japan
| | - Shinno Iijima
- Division of Rehabilitation, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Yasuhisa Fukawa
- Division of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Guo H, Zhao W, Wang A, Li M, Ma H, Wang F, Wang Q, Ba X. The value of sex-specific abdominal visceral fat as measured via CT as a predictor of clear renal cell carcinoma T stage. Adipocyte 2021; 10:285-292. [PMID: 34014795 PMCID: PMC8143252 DOI: 10.1080/21623945.2021.1924957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Wenlei Zhao
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Aijie Wang
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affilicated Hospital of Shandong First Medical University, Jinan, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
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19
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Saravana-Bawan B, Goplen M, Alghamdi M, Khadaroo RG. The Relationship Between Visceral Obesity and Post-operative Complications: A Meta-analysis. J Surg Res 2021; 267:71-81. [PMID: 34130241 DOI: 10.1016/j.jss.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2021] [Accepted: 04/10/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Body composition can have important influence on surgical outcome. There is substantial literature examining sarcopenia, however much less in known about the impact of fat. Visceral fat area (VFA) is a reliable measures of fat distribution that can be quantified with CT scan. The aim of this study is to determine the impact of VFA to predict complications and mortality after emergent or elective surgery. MATERIALS AND METHODS A systematic review and meta-analysis was performed in accordance with the Preferred.
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Affiliation(s)
| | - Michael Goplen
- Department of Surgery, University of Alberta, Edmonton, Canada
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Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13102410. [PMID: 34067568 PMCID: PMC8156120 DOI: 10.3390/cancers13102410] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia. Abstract The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
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The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases. World J Surg 2021; 45:2218-2226. [PMID: 33842995 PMCID: PMC8154807 DOI: 10.1007/s00268-021-06073-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.
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Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study. BMC Gastroenterol 2021; 21:74. [PMID: 33593282 PMCID: PMC7885483 DOI: 10.1186/s12876-021-01652-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. METHODS We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. RESULTS No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10-2 [1.27 × 10-2-2.34 × 10-2] mg/kg vs. 1.48 × 10-2 [1.08 × 10-2-2.03 × 10-2] mg/kg vs. 1.16 × 10-2 [0.98 × 10-2-1.54 × 10-2] mg/kg, P < 0.001; pethidine: 0.63 [0.55-0.72] mg/kg vs. 0.50 [0.46-0.56] mg/kg vs. 0.39 [0.32-0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). CONCLUSIONS This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.
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Hara T, Kogure E, Kubo A, Kakuda W. Preoperative Improvement in Physical Function by Comprehensive Rehabilitation Leads to Decreased Postoperative Complications in Gastrointestinal Cancer Patients. Prog Rehabil Med 2021; 6:20210001. [PMID: 33426362 PMCID: PMC7788086 DOI: 10.2490/prm.20210001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives: The aim of this study was to investigate how baseline laboratory data and changes in
physical function due to preoperative rehabilitation training in gastrointestinal cancer
(GIC) patients can influence the frequency of postoperative complications (PCs). Methods: We enrolled 45 patients who were scheduled for elective surgery for GIC (27 men and 18
women, mean age 63.6±9.5 years). All patients underwent a medical examination and
received general instruction from a rehabilitation physician and exercise instruction
from a physical therapist from 7 to 34 days before the surgery. PCs were graded using
the Clavien-Dindo classification based on the medical records 1 month postoperatively.
We measured the grip strength and the isometric knee extension torque and conducted the
6-min walk test (6MWT) at baseline and just before surgery. The surgical duration, blood
loss, and blood transfusion data were collected. Baseline laboratory information,
including C-reactive protein levels, serum albumin levels, platelet count, white blood
cell count, and the estimated glomerular filtration rate, was recorded. Results: The frequency of PCs was negatively correlated to the change in the 6MWT (β=−0.36) and
positively correlated to the surgical duration (β=0.41). Baseline albumin was positively
correlated to the change in the 6MWT distance (β=0.35). This model demonstrated an
acceptable fit to the data (goodness of fit index=0.980, comparative fit index=1.000,
root mean square error of approximation=0.000). Conclusions: The improvement of gait ability achieved with preoperative rehabilitation training in
patients undergoing elective GIC surgery led to decreased PCs.
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Affiliation(s)
- Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Eisuke Kogure
- Rehabilitation Progress Center Incorporated, Tokyo, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Zhou MJ, Tseng L, Guo X, Jin Z, Bentley-Hibbert S, Shen S, Araujo JL, Spinelli CF, Altorki NK, Sonett JR, Neugut AI, Abrams JA. Low Subcutaneous Adiposity and Mortality in Esophageal Cancer. Cancer Epidemiol Biomarkers Prev 2020; 30:114-122. [PMID: 33008872 DOI: 10.1158/1055-9965.epi-20-0737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent data suggest that subcutaneous adiposity represents an independent prognostic marker in cancer. We aimed to determine whether subcutaneous adiposity estimated by the subcutaneous adiposity tissue index (SATI) was associated with mortality in esophageal cancer. METHODS We conducted a retrospective analysis of a prospectively enrolled cohort from 2009 to 2015 with esophageal cancer at two major cancer centers. CT scans for initial staging were used to quantify adiposity and skeletal muscle areas. Subjects were categorized as above or below median SATI using sex-specific values. Sarcopenia was defined using previously established skeletal muscle area cutoffs. Cox proportional hazards modeling was performed to determine associations between SATI and all-cause mortality. RESULTS Of the original 167 patients, 78 met inclusion criteria and had CT images available. Mean age was 67 years, 81.8% had adenocarcinoma, and 58.9% had stage 3 or 4 disease. Median follow-up time was 29.5 months. Overall 5-year survival was 38.9% [95% confidence interval (CI), 26.8-50.7]. Lower body mass index, higher Charlson comorbidity score, and more advanced stage were independently associated with low SATI. Patients with low SATI had increased mortality (unadjusted HR 2.23; 95% CI, 1.20-4.12), even when adjusted for sarcopenia or for percent weight loss. In a multivariable model including age, histology, stage, and receipt of curative surgery, the association between low SATI and mortality was attenuated (adjusted HR 1.64; 95% CI, 0.81-3.34). CONCLUSIONS Low subcutaneous adiposity as estimated by SATI may be associated with increased mortality in esophageal cancer. IMPACT Interventions to reduce loss of subcutaneous fat may improve survival in esophageal cancer.
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Affiliation(s)
- Margaret J Zhou
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Tseng
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Xiaotao Guo
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Sherry Shen
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - James L Araujo
- Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York
| | - Cathy F Spinelli
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, New York
| | - Nasser K Altorki
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, New York
| | - Joshua R Sonett
- Department of Thoracic Surgery, Columbia University Irving Medical Center, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Alfred I Neugut
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Julian A Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, New York. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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Abstract
PURPOSE OF REVIEW Obesity and malnutrition are frequently encountered in the hospitalized population. Although malnutrition associated with low or normal body mass index (BMI) is easily identified, malnutrition in obese patients goes frequently unrecognized as their fat mass masks underlying muscle mass deterioration. The purpose of this review is to explore if malnutrition has been studied in the obese hospitalized population and if that may be one of the reasons for the variable results in the obesity outcome data. RECENT FINDINGS Various studies have shown a conflicting association between obesity and outcomes in hospitalized patient population. Most prior studies used BMI alone as an indicator of obesity and although some recent studies have included body fat percentage, muscle mass, and functional status, they still showed variable outcomes. Unfortunately, there are not many studies that looked into nutrition status specifically in obese patients to study the outcomes. Studies evaluating clinical outcomes in obese patients showed a wide range of outcomes; some showed a protective effect while others were neutral. We explored recent data about obesity, malnutrition, and outcomes, where researchers more precisely defined malnutrition and obesity to determine health outcomes.
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The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2716395. [PMID: 32802836 PMCID: PMC7426756 DOI: 10.1155/2020/2716395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/01/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
Purpose This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.
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Ose J, Holowatyj AN, Nattenmüller J, Gigic B, Lin T, Himbert C, Habermann N, Achaintre D, Scalbert A, Keski-Rahkonen P, Böhm J, Schrotz-King P, Schneider M, Ulrich A, Kampman E, Weijenberg M, Gsur A, Ueland PM, Kauczor HU, Ulrich CM. Metabolomics profiling of visceral and abdominal subcutaneous adipose tissue in colorectal cancer patients: results from the ColoCare study. Cancer Causes Control 2020; 31:723-735. [PMID: 32430684 PMCID: PMC7425810 DOI: 10.1007/s10552-020-01312-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Underlying mechanisms of the relationship between body fatness and colorectal cancer remain unclear. This study investigated associations of circulating metabolites with visceral (VFA), abdominal subcutaneous (SFA), and total fat area (TFA) in colorectal cancer patients. METHODS Pre-surgery plasma samples from 212 patients (stage I-IV) from the ColoCare Study were used to perform targeted metabolomics. VFA, SFA, and TFA were quantified by computed tomography scans. Partial correlation and linear regression analyses of VFA, SFA, and TFA with metabolites were computed and corrected for multiple testing. Cox proportional hazards were used to assess 2-year survival. RESULTS In patients with metastatic tumors, SFA and TFA were statistically significantly inversely associated with 16 glycerophospholipids (SFA: pFDR range 0.017-0.049; TFA: pFDR range 0.029-0.048), while VFA was not. Doubling of ten of the aforementioned glycerophospholipids was associated with increased risk of death in patients with metastatic tumors, but not in patients with non-metastatic tumors (phet range: 0.00044-0.049). Doubling of PC ae C34:0 was associated with ninefold increased risk of death in metastatic tumors (Hazard Ratio [HR], 9.05; 95% confidence interval [CI] 2.17-37.80); an inverse association was observed in non-metastatic tumors (HR 0.17; 95% CI 0.04-0.87; phet = 0.00044). CONCLUSION These data provide initial evidence that glycerophospholipids in metastatic colorectal cancer are uniquely associated with subcutaneous adiposity, and may impact overall survival.
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Affiliation(s)
- Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Andreana N Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Johanna Nattenmüller
- Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Nina Habermann
- Genome Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - David Achaintre
- International Agency Research on Cancer (IARC), Lyon, France
| | | | | | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Petra Schrotz-King
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Matty Weijenberg
- Department of Epidemiology, GROW - School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
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Gao B, Liu Y, Ding C, Liu S, Chen X, Bian X. Comparison of visceral fat area measured by CT and bioelectrical impedance analysis in Chinese patients with gastric cancer: a cross-sectional study. BMJ Open 2020; 10:e036335. [PMID: 32709647 PMCID: PMC7380841 DOI: 10.1136/bmjopen-2019-036335] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Bioelectrical impedance analysis (BIA) is a simple and inexpensive method to estimate body composition. However, the accuracy of BIA is unknown. We aimed to assess the accuracy of BIA in estimating visceral fat area (VFA) in patients with gastric cancer. STUDY DESIGN This was a cross-sectional study comparing the accuracy of BIA in estimating VFA with the gold standard method measured by CT. VFA was measured in enrolled patients both by CT and BIA. VFA by CT at umbilical level ≥100 cm2 was considered as visceral obesity. Reliability between the two methods was assessed by intraclass correlation coefficient (ICC) and consistency was assessed by Bland-Altman method (95% limits of agreement). The area under the receiver operating characteristic curve (AUROC) was used to assess the performance of BIA in diagnosing visceral obesity. SETTING The study was conducted in China. PARTICIPANTS From 1 January 2017 to 1 December 2018, a total of 157 patients diagnosed with gastric cancer were enrolled. RESULTS Overall, VFA by CT and BIA in patients was 84.39±46.43 cm2 and 71.94±22.44 cm2, respectively. VFA estimated by BIA was positively correlated with VFA measured by CT using Pearson's test (r=0.650, p<0.001). Overall, ICC for the two methods was 0.675. The mean bias between the two measurements was 12.45±36.13 cm2. The 95% limits of agreement ranged from -58.36 cm2 to 83.26 cm2. The cut-off value for diagnosing visceral obesity by BIA was 81 cm2 (AUROC: 0.822, p<0.001, 95% CI 0.758 to 0.887). CONCLUSIONS VFA measured by BIA showed satisfactory reliability with that measured by CT. However, the absolute values of the two methods were not interchangeable. The cut-off value for VFA by BIA in diagnosing visceral obesity was 81 cm2 for patients with gastric cancer in the Chinese population.
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Affiliation(s)
- Bo Gao
- Department of Clinical Nutrition, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University; Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Chao Ding
- Department of General Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Shunli Liu
- Department of Radiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Xiaojie Bian
- Department of Pharmacy, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
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Iranmanesh P, Delaune V, Meyer J, Liot E, Konrad B, Ris F, Toso C, Buchs NC. Comparison of Outcomes between Obese and Non-Obese Patients in a Colorectal Enhanced Recovery After Surgery (ERAS) Program: A Single-Center Cohort Study. Dig Surg 2020; 37:420-427. [PMID: 32434182 DOI: 10.1159/000507545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/26/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Obese patients are considered at increased risk of postoperative adverse events after colorectal surgery. OBJECTIVE The objective of the present study was to compare postoperative outcomes between obese and non-obese patients undergoing elective colorectal surgery in an Enhanced Recovery After Surgery (ERAS) program. METHODS A retrospective analysis of a prospective cohort including patients who underwent elective colorectal surgery and were included in an ERAS protocol between February 2014 and December 2017 at Geneva University Hospital, Geneva, Switzerland, was performed. Postoperative outcomes of obese and non-obese patients were compared. RESULTS Data of 460 patients were analyzed, including 374 (81%) non-obese and 86 (19%) obese patients. Overall, there was no difference in postoperative outcomes between the 2 groups. Among patients undergoing oncologic surgery, obese subjects had a significantly higher rate of conversion to laparotomy (11.9 vs. 2.1%, p = 0.01) and longer time until return of bowel function (2.38 vs. 1.98 days, p = 0.03), without increased morbidity or longer length of stay. CONCLUSION Obese and non-obese patients had similar postoperative outcomes after elective colorectal surgery with ERAS management. ERAS can potentially reduce the increased morbidity usually observed in obese patients following elective colorectal surgery.
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Affiliation(s)
- Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland,
| | - Vaihere Delaune
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Beatrice Konrad
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Frederic Ris
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Nicolas Christian Buchs
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
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Akay S, Urkan M, Balyemez U, Erşen M, Taşar M. Is visceral obesity associated with colorectal cancer? The first volumetric study using all CT slices. ACTA ACUST UNITED AC 2020; 25:338-345. [PMID: 31287430 DOI: 10.5152/dir.2019.18350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We aimed to examine the possible relationship between abdominal adiposity parameters and the presence of colorectal cancer (CRC) and between these adiposity parameters and various histopathologic findings of the tumor. METHODS A total of 60 control subjects and 111 CRC patients, 63 with early-stage and 48 with advanced-stage disease, were enrolled. Medical data and abdominopelvic computed tomography (CT) examinations of each study group were retrospectively reviewed. Abdominal adiposity parameters, including visceral adipose tissue (VAT) volume, subcutaneous adipose tissue (SAT) volume, and total adipose tissue (TAT) volume, were calculated on all slices of the CT examinations with specialized software, and results for each study group were compared. Adiposity parameters were also compared with tumor histopathologic findings. RESULTS We found lower VAT and higher SAT volumes in advanced-stage CRC patients, compared with the early-stage group. However, this relationship was not statistically significant (P = 0.721 for VAT and P = 0.432 for SAT volumes). We detected significantly lower VAT and SAT volumes in the early-stage CRC group compared with the control group (P = 0.014 for both). There was no significant relationship between TAT volumes and the study groups (P = 0.06). No statistically significant relationship was detected between adipose tissue parameters and histopathologic features of the CRC group (P > 0.05). CONCLUSION We found statistically significant lower VAT and SAT volumes in patients with early-stage CRC compared with the control group. Volumetric adipose tissue measurements may be more accurate than area measurements and can easily be performed on abdominopelvic CT examination, which is the routine imaging modality for CRC patients.
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Affiliation(s)
- Sinan Akay
- Department of Radiology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Urkan
- Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uğurcan Balyemez
- Department of Radiology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Erşen
- Department of Radiology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Taşar
- Department of Radiology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
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The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat. JOURNAL OF ONCOLOGY 2019; 2019:8404383. [PMID: 31929799 PMCID: PMC6942899 DOI: 10.1155/2019/8404383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Background Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P < 0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P < 0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.
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Kayano H, Nomura E, Abe R, Ueda Y, Machida T, Fujita C, Uchiyama S, Endo K, Murakami K, Mukai M, Makuuchi H. Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study. BMC Surg 2019; 19:181. [PMID: 31779610 PMCID: PMC6883515 DOI: 10.1186/s12893-019-0629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
Background Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis. Methods Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables. Results The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm2/m2 for males and 2.89 cm2/m2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257). Conclusions PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.
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Affiliation(s)
- Hajime Kayano
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
| | - Eiji Nomura
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Rin Abe
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Yasuhiko Ueda
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Takashi Machida
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Chikara Fujita
- Departments of Radiation Technology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Shohei Uchiyama
- Departments of Radiation Technology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Kazuyuki Endo
- Departments of Radiation Technology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Katsuki Murakami
- Departments of Radiation Technology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Masaya Mukai
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Hiroyasu Makuuchi
- Departments of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
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Hara T, Kogure E, Kubo A. Onset factors of infective and non-infective complications in perioperative gastrointestinal cancer patients. J Phys Ther Sci 2019; 31:516-520. [PMID: 31417213 PMCID: PMC6642895 DOI: 10.1589/jpts.31.516] [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: 02/01/2019] [Accepted: 04/03/2019] [Indexed: 12/02/2022] Open
Abstract
[Purpose] This study aimed to examine the causes of post-surgical infective and
non-infective complications and to examine the possibility of physical therapy for
preventing postoperative complications in gastrointestinal cancer patients. [Participants
and Methods] The study participants were 119 perioperative gastrointestinal cancer
patients [69 males and 50 females, aged 62.2 ± 11.2 years (mean ± standard deviation)]
classified into three groups according to whether they had infective complications,
non-infective complications, or the absence of complications. Data on onset factors for
complications, basic information, surgical information, biochemical data, respiratory
function, physical function, physique, and body composition were collected from a previous
study. [Results] In the group with onset factors of infective complications, blood loss,
the C-reactive protein level on the third postoperative day, and the forced expiratory
volume % in 1 second were found to be significant explanatory variables. In the group with
onset factors of non-infective complications, surgical time was detected as a significant
explanatory variable. [Conclusion] In gastrointestinal cancer patients, surgical
information affected the onset of infective and non-infective complications. However, only
infective complications had the onset factors of postoperative immune response and
preoperative respiratory function. Preoperative physical therapy may be an option for the
prevention of postoperative complications in gastrointestinal cancer patients.
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Affiliation(s)
- Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare: 2600-1 Kitakanemaru, Ootawara-shi, Tochigi 324-8501, Japan
| | | | - Akira Kubo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare: 2600-1 Kitakanemaru, Ootawara-shi, Tochigi 324-8501, Japan
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Zhai TS, Kang Y, Ren WH, Liu Q, Liu C, Mao WZ. Elevated visceral fat area is associated with adverse postoperative outcome of radical colectomy for colon adenocarcinoma patients. ANZ J Surg 2019; 89:E368-E372. [PMID: 31206986 DOI: 10.1111/ans.15283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the impact of visceral obesity quantified by preoperative computed tomography on short-term postoperative outcomes compared with body mass index (BMI) in stage I-III colon adenocarcinoma patients. METHODS In this retrospective study, 107 patients treated with radical colectomy for stage I-III colon adenocarcinoma were classified as obese or non-obese by computed tomography-based measures or BMI (obese: BMI ≥28 kg/m2 , visceral fat area (VFA) to subcutaneous fat area ratio (V/S) ≥0.4, and VFA ≥100 cm2 ). Clinical variables, operation time, estimated blood loss, pathologic stage, histologic grade, postoperative complications, postoperative stay and hospitalization expenses were compared. RESULTS Obese patients by VFA were more likely to have higher postoperative complication rate (32.9 versus 11.8%, P = 0.021), have longer operation time (184.6 ± 49.5 versus 163.1 ± 44.1 min, P = 0.033), postoperative stay (15.21 ± 7.59 versus 12.29 ± 5.40 days, P = 0.047) and cost more ($10 758.7 ± 3271.7 versus $9232.0 ± 2994.6, P = 0.023) than non-obese. CONCLUSION Visceral obesity graded by VFA is associated with increased postoperative morbidity, operation time, postoperative stay and hospitalization expenses for colon adenocarcinoma patients and may be superior to BMI or V/S for the prediction of colon surgery.
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Affiliation(s)
- Ting-Shuai Zhai
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China.,Department of Urology, Shanghai Tenth People's Hospital of Tongji University, School of Medicine, Shanghai, China
| | - Yuan Kang
- Department of Clinical Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Wen-Hao Ren
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Qi Liu
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Chao Liu
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Wei-Zheng Mao
- Department of General Surgery, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
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Srikumar T, Siegel EM, Gu Y, Balagurunathan Y, Garcia AL, Chen YA, Zhou JM, Zhao X, Gillies R, Clark W, Gamenthaler A, Choi J, Shibata D. Semiautomated Measure of Abdominal Adiposity Using Computed Tomography Scan Analysis. J Surg Res 2019; 237:12-21. [PMID: 30694786 PMCID: PMC7771581 DOI: 10.1016/j.jss.2018.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/19/2018] [Accepted: 11/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The obesity epidemic has prompted the need to better understand the impact of adipose tissue on human pathophysiology. However, accurate, efficient, and replicable models of quantifying adiposity have yet to be developed and clinically implemented. We propose a novel semiautomated radiologic method of measuring the visceral fat area (VFA) using computed tomography scan analysis. MATERIALS AND METHODS We obtained a cohort of 100 patients with rectal adenocarcinoma, with a median age of 60.9 y (age range: 35-87 y) and an average body mass index of 28.8 kg/m2 ± 6.56 kg/m2. The semiautomated quantification method of adiposity was developed using a commercial imaging suite. The method was compared to two manual delineations performed using two different picture archiving communication systems. We quantified VFA, subcutaneous fat area (SFA), total fat area (TFA), and visceral-to-subcutaneous fat ratio (V/S ratio) on computed tomography axial slices that were at the L4-L5 intervertebral level. RESULTS The semiautomated method was comparable to manual measurements for TFA, VFA, and SFA with intraclass correlation (ICC) of 0.99, 0.97, and 0.96, respectively. However, the ICC for the V/S ratio was only 0.44, which led to the identification of technical outliers that were identified using robust regression. After removal of these outliers, the ICC improved to 0.99 for TFA, VFA, and SFA and 0.97 for the V/S ratio. Measurements from the manual methodology highly correlated between the two picture archiving communication system platforms, with ICC of 0.98 for TFA, 0.98 for VFA, 0.96 for SFA, and 0.95 for the V/S ratio. CONCLUSIONS This semiautomated method is able to generate precise and reproducible results. In the future, this method may be applied on a larger scale to facilitate risk stratification of patients using measures of abdominal adiposity.
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Affiliation(s)
- Thejal Srikumar
- Departments of Cancer Epidemiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Erin M Siegel
- Departments of Cancer Epidemiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Yuhua Gu
- Departments of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Yoganand Balagurunathan
- Departments of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Alberto L Garcia
- Departments of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Y Ann Chen
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Jun-Min Zhou
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Xiuhua Zhao
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Robert Gillies
- Departments of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Whalen Clark
- Departments of Gastrointestinal Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Andrew Gamenthaler
- Departments of Gastrointestinal Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - Junsung Choi
- Departments of Interventional Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - David Shibata
- Departments of Gastrointestinal Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida.
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Ulrich CM, Gigic B, Böhm J, Ose J, Viskochil R, Schneider M, Colditz GA, Figueiredo JC, Grady WM, Li CI, Shibata D, Siegel EM, Toriola AT, Ulrich A. The ColoCare Study: A Paradigm of Transdisciplinary Science in Colorectal Cancer Outcomes. Cancer Epidemiol Biomarkers Prev 2018; 28:591-601. [PMID: 30523039 DOI: 10.1158/1055-9965.epi-18-0773] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/15/2018] [Accepted: 11/26/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Colorectal cancer is a leading cause of cancer death. Biomarkers to predict treatment outcomes are needed, as is evidence whether postdiagnosis diet and lifestyle can affect well-being and clinical outcomes. The international ColoCare Consortium aims to identify new biologic markers (e.g., metabolomic, transcriptomic, metagenomic, genetic, epigenetic, proteomic markers) that predict clinical outcomes, and to characterize associations between modifiable risk factors (e.g., diet, supplement use, physical activity) with short-term and long-term patient-reported and clinical outcomes among patients with colorectal cancer.Methods/Results: ColoCare is recruiting newly diagnosed patients with colorectal cancer across six sites in the United States and one site in Germany. As of April 2018, we have recruited >2,000 patients across all sites. Our projected enrollment is >4,000 multiethnic patients with colorectal cancer. The study includes uniformly collected, comprehensive sets of data and biospecimens at multiple time points up to 5 years after diagnosis. Treatment and clinical data are abstracted from medical records and centrally harmonized. Biospecimens are archived according to standardized procedures. Our initial studies demonstrated metabolic differences in adipose tissue types. We further reported on associations of biological factors (e.g., inflammation, DNA methylation, metabolomics) with lifestyle factors (e.g., adiposity, smoking, physical activity, dietary supplement use) or joint associations with clinical outcomes. CONCLUSIONS ColoCare is a consortium for the investigation of multilevel factors relevant to colorectal cancer survivorship. IMPACT The combination of a comprehensive set of biospecimens collected at multiple time points, jointly with detailed assessments of health behaviors and other prognostic factors, results in a unique resource that facilitates wide-ranging, innovative, and impactful research on colorectal cancer.
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Affiliation(s)
- Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah.
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Richard Viskochil
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - William M Grady
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Erin M Siegel
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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Himbert C, Ose J, Nattenmüller J, Warby CA, Holowatyj AN, Böhm J, Lin T, Haffa M, Gigic B, Hardikar S, Scherer D, Zielske L, Schrotz-King P, Kölsch T, Siegel EM, Shibata D, Ulrich A, Schneider M, Hursting SD, Kauczor HU, Ulrich CM. Body Fatness, Adipose Tissue Compartments, and Biomarkers of Inflammation and Angiogenesis in Colorectal Cancer: The ColoCare Study. Cancer Epidemiol Biomarkers Prev 2018; 28:76-82. [PMID: 30333223 DOI: 10.1158/1055-9965.epi-18-0654] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/09/2018] [Accepted: 10/10/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Adiposity has been linked to both risk and prognosis of colorectal cancer; however, the impact of different fat areas [visceral (VFA) vs. subcutaneous fat area (SFA)] is unclear. We investigated associations between adiposity and biomarkers of inflammation and angiogenesis among patients with colorectal cancer. METHODS Preoperative serum samples and computed tomography scans were obtained from 188 patients diagnosed with primary invasive stage I-IV colorectal cancer enrolled in the ColoCare Study. Adiposity was assessed by area-based quantification of VFA, SFA, and VFA:SFA ratio on spinal levels L3/L4 and L4/L5. Circulating levels of inflammation (CRP, SAA, sICAM-1, and sVCAM-1) and angiogenesis (VEGF-A and VEGF-D) were assessed from patient sera on the Meso Scale Discovery platform. Partial correlations and regression analyses, adjusted for age, sex, and tumor stage, were performed. RESULTS VFA was moderately correlated with CRP and SAA (CRP: L3/L4 and L4/L5:r = 0.21, P = 0.01; SAA: L3/L4:r = 0.17, P = 0.04). The correlation between SFA and the measured biomarkers were weak (r ≤ 0.13, not significant). The ratio of VFA:SFA at L3/L4 was moderately correlated with VEGF-A (r = 0.28, P = 0.0008) and SAA (r = 0.24, P = 0.006), and less so with CRP (r = 0.18, P = 0.04) and sICAM-1 (r = 0.18, P = 0.04). Similar correlations were found for the VFA:SFA ratio at L4/L5. CONCLUSIONS We observed an association between visceral adiposity and biomarkers of inflammation and angiogenesis in colorectal cancer. In particular, the VFA:SFA ratio was correlated with circulating levels of the proangiogenic biomarker VEGF-A. IMPACT Our findings support a direct association of visceral adipose tissue with inflammatory and angiogenic processes, which play fundamental roles in the development and progression of colorectal cancer.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Johanna Nattenmüller
- Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Christy A Warby
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Andreana N Holowatyj
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Mariam Haffa
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Sheetal Hardikar
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dominique Scherer
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Lin Zielske
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Schrotz-King
- National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Torsten Kölsch
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Erin M Siegel
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | | | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah.
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta-analysis. Colorectal Dis 2018; 20:O215-O225. [PMID: 29897171 DOI: 10.1111/codi.14292] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/29/2018] [Indexed: 02/08/2023]
Abstract
AIM Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta-analysis of all available prospective data. METHODS This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien-Dindo Grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. RESULTS This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49-2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, P < 0.001) compared to normal weight patients. CONCLUSIONS In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease.
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Martin L, Hopkins J, Malietzis G, Jenkins JT, Sawyer MB, Brisebois R, MacLean A, Nelson G, Gramlich L, Baracos VE. Assessment of Computed Tomography (CT)-Defined Muscle and Adipose Tissue Features in Relation to Short-Term Outcomes After Elective Surgery for Colorectal Cancer: A Multicenter Approach. Ann Surg Oncol 2018; 25:2669-2680. [PMID: 30006691 DOI: 10.1245/s10434-018-6652-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sarcopenia, visceral obesity (VO), and reduced muscle radiodensity (myosteatosis) are suggested risk factors for postoperative morbidity in colorectal cancer (CRC), but usually are not concurrently assessed. Published thresholds used to define these features are not CRC-specific and are defined in relation to mortality, not postoperative outcomes. This study aimed to evaluate body composition in relation to length of hospital stay (LOS) and postoperative outcomes. METHODS Pre-surgical computed tomography (CT) images were assessed for total area and radiodensity of skeletal muscle and visceral adipose tissue in a pooled Canadian and UK cohort (n = 2100). Sex- and age-specific values for these features were calculated. For 1139 of 2100 patients, LOS data were available, and sex- and age-specific thresholds for sarcopenia, myosteatosis, and VO were defined on the basis of LOS. Association of CT-defined features with LOS and readmissions was explored using negative binomial and logistic regression models, respectively. RESULTS In the multivariable analysis, the predictors of LOS (P < 0.001) were age, surgical approach, major complications (incidence rate ratio [IRR] 2.42; 95% confidence interval [CI] 2.18-2.68), study cohort, and three body composition profiles characterized by myosteatosis combined with either sarcopenia (IRR, 1.27; 95% CI 1.12-1.43) or VO (IRR, 1.25; 95% CI 1.10-1.42), and myosteatosis combined with both sarcopenia and VO (IRR, 1.58; 95% CI 1.29-1.93). In the multivariable analysis, risk of readmission was associated with VO alone (odds ratio [OR] 2.66; 95% CI 1.18-6.00); P = 0.018), VO combined with myosteatosis (OR, 2.72; 95% CI 1.36-5.46; P = 0.005), or VO combined with myosteatosis and sarcopenia (OR, 2.98; 95% CI 1.06-5.46; P = 0.038). Importantly, the effect of body composition profiles on LOS and readmission was independent of major complications. CONCLUSION The findings showed that CT-defined multidimensional body habitus is independently associated with LOS and hospital readmission.
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Affiliation(s)
- Lisa Martin
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Jessica Hopkins
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Georgios Malietzis
- Department of Surgery, St. Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J T Jenkins
- Department of Surgery, St. Mark's Hospital, Harrow, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Michael B Sawyer
- Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Ron Brisebois
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Anthony MacLean
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Gregg Nelson
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Department of Oncology, 4023 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
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Elevated visceral obesity quantified by CT is associated with adverse postoperative outcome of laparoscopic radical nephrectomy for renal clear cell carcinoma patients. Int Urol Nephrol 2018; 50:845-850. [DOI: 10.1007/s11255-018-1858-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
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