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Chen WZ, Lin F, Yu DY, Ren Q, Zhang FM, Shen ZL, Chen WH, Dong QT, Yu Z. Clinical impact of sarcopenia for overweight or obese patients with colorectal cancer. Jpn J Clin Oncol 2024; 54:23-30. [PMID: 37850297 DOI: 10.1093/jjco/hyad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Sarcopenia, overweight and obesity are all dynamic changes in body composition, which may have a negative effect on the prognosis for patients with colorectal cancer. The aim of this study was to investigate the predictive role of sarcopenia on overweight or obese patients with colorectal cancer. METHODS We conducted an observative study on the population of overweight or obese patients with colorectal cancer who underwent curative surgeries in two centers between 2015 and 2021. They were grouped by the presence of sarcopenia. Propensity score match analysis was used to balance the baseline of clinicopathologic characteristics of the two groups. Then, the postoperative outcomes between the two groups were compared. Independent risk factors were evaluated for complications using univariate and multivariate analysis. RESULTS Of 827 patients enrolled, 126 patients were matched for analysis. Patients with sarcopenia had a higher incidence of total complication and medical complications, a higher rate of laparoscopic surgery performed and higher hospitalization costs. Old age (≥65 years, P = 0.012), ASA grade (III, P = 0.008) and sarcopenia (P = 0.036) were independent risk factors for total complications. ASA grade (III, P = 0.002) and sarcopenia (P = 0.017) were independent risk factors for medical complications. CONCLUSIONS Sarcopenia was prevalent among overweight or obese patients with colorectal cancer and was associated with negative postoperative outcomes. Early recognition of changes in body composition could help surgeons be well prepared for surgical treatment for overweight or obese patients.
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Affiliation(s)
- Wei-Zhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Feng Lin
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Ding-Ye Yu
- Department of General Surgery, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai
| | - Qi Ren
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Zi-Le Shen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Wen-Hao Chen
- Department of General Surgery, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai
| | - Qian-Tong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
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2
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Ruck JM, Shui AM, Jefferis AA, Rojo AD, Rahimi RS, Ganger DR, Verna EC, Kappus M, Ladner DP, Segev DL, Volk M, Tevar A, King EA, Lai JC. Association of body mass index with post-liver transplant outcomes. Clin Transplant 2024; 38:e15205. [PMID: 38041450 PMCID: PMC10918560 DOI: 10.1111/ctr.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Patients with obesity have inferior outcomes after general surgery procedures, but studies evaluating post-liver transplant (LT) outcomes have been limited by small sample sizes or lack of granularity of outcomes. We evaluated the relationship between obesity and post-LT outcomes, including those observed in other populations to be obesity-related. METHODS Included were 1357 LT recipients prospectively enrolled in the ambulatory pre-LT setting at 8 U.S. CENTERS Recipient were categorized by body mass index (BMI, kg/m2 ): non-obese (BMI < 30), class 1 obesity (BMI 30-<35), and classes 2-3 obesity (BMI ≥ 35). Post-transplant complications were compared by BMI using Chi-square and rank-sum testing, logistic regression, Kaplan-Meier curves, and Cox regression. RESULTS Classes 2-3 obesity was associated with higher adjusted odds than non-obesity of venous thrombosis [adjusted odds ratio (aOR) 2.06, 95% CI 1.01-4.23, p = .047] and wound dehiscence (aOR 2.45, 95% CI 1.19-5.06, p = .02). Compared with non-obese recipients, post-LT hospital stay was significantly longer for recipients with classes 2-3 obesity [p = .01; median (Q1-Q3) 9 (6-14) vs. 8 (6-12) days) or class 1 obesity [p = .002; 9 (6-14) vs. 8 (6-11) days]. Likelihood of ICU readmission, infection, discharge to a non-home facility, rejection, 30-day readmission, and 1-year readmission were similar across BMI categories (all p > .05). CONCLUSION Compared to non-obese recipients, obese recipients had similar post-LT survival but longer hospital stay and higher likelihood of wound dehiscence and venous thrombosis. These findings underscore that obesity alone should not preclude LT, but recipients with obesity should be monitored for obesity-related complications such as wound dehiscence and venous thrombosis.
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Affiliation(s)
- Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Alexis A. Jefferis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andres Duarte Rojo
- Center for Liver Diseases, Thomas A. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert S. Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA
| | - Daniel R. Ganger
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Kappus
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniela P. Ladner
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine and Langone Health, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine and Langone Health, New York, New York, USA
| | - Michael Volk
- Division of Gastroenterology & Hepatology, and Transplantation Institute, Loma Linda University Health, Loma Linda, California, USA
| | - Amit Tevar
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth A. King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer C. Lai
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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3
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McKechnie T, Lee Y, Hong D, Dionne J, Doumouras A, Parpia S, Bhandari M, Eskicioglu C. A history of bariatric surgery before surgery for colorectal cancer may improve short-term postoperative outcomes: Analysis of the national inpatient sample 2015-2019. Surgery 2023; 174:1168-1174. [PMID: 37709649 DOI: 10.1016/j.surg.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective and sustainable form of weight loss. Bariatric surgery before elective operations for colorectal pathology may improve postoperative outcomes. To compare patients with and without prior bariatric surgery undergoing surgery for colorectal cancer in terms of postoperative morbidity and health care use. METHODS Adult patients undergoing resection for colorectal cancer from 2015 to 2019 were identified from the National Inpatient Sample. Patients were stratified according to their history of bariatric surgery. Propensity score matching with 4:1 nearest-neighbor matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, postoperative length of stay, total admission health care cost, and post-discharge disposition. McNemar's test and Wilcoxon matched-pairs signed-rank test were performed. RESULTS After propensity score matching, 1,197 patients without prior bariatric surgery and 376 patients with prior bariatric surgery were included. Patients with prior bariatric surgery had an absolute reduction of 6.5% in overall in-hospital postoperative morbidity (19.1% vs 25.6%, P < .0001), a $5,256 decrease in hospitalization cost ($70,344 vs $75,600, P = .034), and were more likely to be discharged home after their index operation (72.9% vs 63.9%, P < .0001). CONCLUSION Bariatric surgery before surgery for colorectal cancer may be associated with decreased postoperative morbidity and health care use. Bariatric surgery and other forms of rapid and effective weight loss, such as very low-energy diets, should be evaluated further for the optimization of obese patients before nonbariatric abdominal surgery.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/tylermckechnie
| | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA. https://twitter.com/YungLeeMD
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. https://twitter.com/Drbariatricsx
| | - Joanna Dionne
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada. https://twitter.com/Doctor_Doum
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada.
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Grimes AD, Stewart KE, Morris KT, Dunn GD, Booth KK, Carter SN, Garwe T, Sarwar Z, Fischer LE. The Effect of Body Mass Index on the Creation of an End-Colostomy in Rectal Cancer Patients. Am Surg 2023; 89:4940-4943. [PMID: 34633227 DOI: 10.1177/00031348211047474] [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: 11/17/2022]
Abstract
With the increasing prevalence of obesity, there has been a parallel increase in the incidence of rectal cancer. The association of body mass index (BMI) and end-colostomy creation versus primary anastomosis in patients undergoing proctectomy for rectal cancer has not been described. This is a retrospective study of patients with rectal cancer from 2012 to 2018 using data from the National Surgical Quality Improvement Project. 16,446 (92.1%) underwent primary anastomosis and 1,418 (7.9%) underwent creation of an end-colostomy. Patients with a BMI of 25-29.9 (overweight) comprised the most frequent group to have a proctectomy (reference group), but the least likely to have an end-colostomy. Patients with severe obesity (BMI 50+) had an adjusted odds ratio for end-colostomy of 2.7 (95% CI 1.5-4.7) compared to the reference group. Patients who have severe obesity should be counseled regarding the likelihood of an end-colostomy and may benefit from medical weight management or weight-loss surgery.
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Affiliation(s)
- Arthur D Grimes
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Kenneth E Stewart
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | | | - Gary D Dunn
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Kristina K Booth
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Steven N Carter
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Tabitha Garwe
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Zoona Sarwar
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Laura E Fischer
- Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA
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5
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Chen H, Ye L, Huang C, Shi Y, Lin F, Ye H, Huang Y. Indocyanine green angiography for lower incidence of anastomotic leakage after transanal total mesorectal excision: a propensity score-matched cohort study. Front Oncol 2023; 13:1134723. [PMID: 37361602 PMCID: PMC10289152 DOI: 10.3389/fonc.2023.1134723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background Anastomotic leakage (AL) is the most serious complication that can arise during colorectal surgery. Indocyanine green (ICG) angiography offers an intraoperative assessment of colonic vascular perfusion in real time. We aimed to assess ICG's effects on the AL rate in patients who have undergone transanal total mesorectal excision (TaTME) for rectal cancer. Methods This retrospective cohort study was conducted at our center from October 2018 to March 2022 to analyze the clinical data of patients with rectal cancer who have undergone TaTME after propensity score matching (PSM). The primary outcome was the proximal colonic transection line modification and clinical AL rate. Results A total of 143 patients in the non-ICG group and 143 patients in the ICG group were included after PSM. The proximal colonic transection line of seven patients in the non-ICG group was modified, while 18 were in the ICG group (4.9% vs. 12.5%, p = 0.023). Twenty-three patients (16.1%) in the non-ICG group and five patients (3.5%) in the ICG group were diagnosed with AL (p < 0.001). The ICG group had a less hospital readmission rate than the non-ICG group (0.7% vs. 7.7%, p = 0.003). The between-group differences in basic line and other outcomes were not significant. Conclusions ICG angiography is a safe and feasible method to help surgeons identify potentially poor colonic vascular perfusion and modify the proximal colonic transection line, resulting in a significant reduction in AL and hospital readmission rates.
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Affiliation(s)
- Hengkai Chen
- Department of Colorectal Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Linfang Ye
- Department of Colorectal Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Medical University, Fuzhou, China
| | | | | | | | | | - Yongjian Huang
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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6
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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: 0] [Impact Index Per Article: 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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7
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Liu J, Li G, Chen Z, Jiang H. A meta-analysis of the effect of different body mass index on surgical wound infection after colorectal surgery. Int Wound J 2023. [PMID: 36860168 DOI: 10.1111/iwj.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 03/03/2023] Open
Abstract
We conducted a meta-analysis to assess the effect of different body mass index on surgical wound infection after colorectal surgery. A systematic literature search up to November 2022 was performed and 2349 related studies were evaluated. The chosen studies comprised 15 595 colorectal surgery subjects participated in the selected studies' baseline trials; 4390 of them were obese according to the selected body mass index cut-off used to measure obesity in the selected studies, while 11 205 were nonobese. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of different body mass index on wound infection after colorectal surgery by the dichotomous methods with a random or fixed effect model. The body mass index ≥30 kg/m2 resulted in significantly higher surgical wound infection after colorectal surgery (OR, 1.76; 95% CI, 1.46-2.11, P < .001) compared with the body mass index <30 kg/m2 . The body mass index ≥25 kg/m2 resulted in significantly higher surgical wound infection after colorectal surgery (OR, 1.64; 95% CI, 1.40-1.92, P < .001) compared with the body mass index <25 kg/m2 . The subjects with higher body mass index had a significantly higher surgical wound infection after colorectal surgery compared with the subjects with normal body mass index.
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Affiliation(s)
- Jiang Liu
- Department of Anorectal Surgery, Shaoxing People's Hospital, Zhejiang, China
| | - Gang Li
- Department of Anorectal Surgery, Shaoxing People's Hospital, Zhejiang, China
| | - Zhiliang Chen
- Department of Anorectal Surgery, Shaoxing People's Hospital, Zhejiang, China
| | - Huafeng Jiang
- Department of Anorectal Surgery, Shaoxing People's Hospital, Zhejiang, China
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8
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Kondo A, Kumamoto K, Asano E, Feng D, Kobara H, Okano K. Indocyanine green fluorescence imaging during laparoscopic rectal cancer surgery could reduce the incidence of anastomotic leakage: a single institutional retrospective cohort study. World J Surg Oncol 2022; 20:397. [PMID: 36514053 PMCID: PMC9746152 DOI: 10.1186/s12957-022-02856-z] [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: 08/09/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is insufficient evidence on whether indocyanine green (ICG) fluorescence angiography can reduce the incidence of anastomotic leakage (AL). This retrospective cohort study aimed to evaluate the effect of ICG fluorescence angiography on AL rates in laparoscopic rectal cancer surgery at a single institution. METHODS Patients who underwent laparoscopic low anterior resection or intersphincteric resection with ICG fluorescence angiography (ICG group; n = 73) and patients who underwent a similar surgical procedure for rectal cancer without ICG fluorescence (non-ICG group; n = 114) were enrolled consecutively in this study. ICG fluorescence angiography was performed prior to transection of the proximal colon, and anastomosis was performed with sufficient perfusion using ICG fluorescence imaging. AL incidence was compared between both groups, and the risk factors for AL were analyzed. RESULTS AL occurred in 3 (4.1%) and 14 (12.3%) patients in the ICG and non-ICG groups, respectively. In the ICG group, the median perfusion time from ICG injection was 34 s, and 5 patients (6.8%) required revision of the proximal transection line. None of the patients requiring revision of the proximal transection line developed AL. In univariate analysis, longer operating time (odds ratio: 2.758; 95% confidence interval: 1.023-7.624) and no implementation of ICG fluorescence angiography (odds ratio: 3.266; 95% confidence interval: 1.038-11.793) were significant factors associated with AL incidence, although the creation of a diverting stoma or insertion of a transanal tube was insignificant. CONCLUSION ICG fluorescence angiography was associated with a significant reduction in AL during laparoscopic rectal cancer surgery. Changes in the surgical plan due to ICG fluorescence visibility may help improve the short-term outcomes of patients with rectal cancer.
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Affiliation(s)
- Akihiro Kondo
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793 Japan
| | - Kensuke Kumamoto
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793 Japan
| | - Eisuke Asano
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793 Japan
| | - Dongping Feng
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793 Japan
| | - Hideki Kobara
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterology and Neurology, Kagawa University, Miki-Cho, Kagawa, Japan
| | - Keiichi Okano
- grid.258331.e0000 0000 8662 309XDepartment of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793 Japan
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9
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Gutierrez L, Bonne A, Trilling B, Foote A, Laverrière MH, Roth G, Fournier J, Girard E, Faucheron JL. Impact of obesity on morbidity and oncologic outcomes after total mesorectal excision for mid and low rectal cancer. Tech Coloproctol 2022; 27:407-418. [PMID: 36326939 DOI: 10.1007/s10151-022-02725-7] [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: 01/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A recent meta-analysis showed that obesity increased the conversion rate and postoperative morbidity of rectal cancer surgery, but did not influence pathological results. However, this meta-analysis included patients with cancer of the upper rectum and had many biases. The aim of the present retrospective study was to investigate the impact of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, on postoperative morbidity and short- and long-term oncologic outcomes of total mesorectal excision for mid and low rectal cancer in consecutive patients. METHODS This study included all eligible patients who were operated on for mid and lower rectal cancer between 1999 and 2018 in our hospital. We compared 90-day postoperative morbidity and mortality, and short- and long-term oncologic outcomes between obese and non-obese patients. RESULTS Three hundred and ninety patients [280 males, mean age 65.7 ± 11.3 years, 59 obese individuals (15.1%)] were included. There was no difference in the 90-day mortality rate between obese and non-obese groups (p = 0.068). There was a difference in the overall 90-day morbidity rate between the obese and non-obese groups that disappeared after propensity score matching of the patients. There was no difference in short-term oncological parameters, with a median follow-up of 43 (20-84) months, and there were no significant differences in disease-free and overall survival between obese and non-obese patients (p = 0.42 and p = 0.11, respectively). CONCLUSIONS Obesity does not affect the 90-day morbidity rate, or short- and long-term oncologic results in patients operated on for mid and lower rectal cancer.
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Affiliation(s)
- L Gutierrez
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - A Bonne
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - B Trilling
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - A Foote
- Research Division, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - M-H Laverrière
- Department of Pathology, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - G Roth
- Department of Hepato-Gastroenterology, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - J Fournier
- Department of Public Health, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - E Girard
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - J-L Faucheron
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France.
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France.
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10
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Poulos CM, Althoff AL, Scott RB, Wakefield D, Lewis R. A novel scoring system for identifying patients at risk for venous thromboembolism undergoing diverticular resection: an American College of Surgeons-National Surgical Quality Improvement Program Study. Surg Endosc 2022; 36:8415-8420. [PMID: 35229213 DOI: 10.1007/s00464-022-09129-6] [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: 09/05/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
Following colorectal surgery, venous thromboembolism (VTE) is a serious complication occurring at an estimated incidence of 2-4%. There is a significant body of literature stratifying risk of VTE in specific populations undergoing colorectal resection for cancer or inflammatory bowel disease. There has been little research characterizing patients undergoing colorectal surgery for other indications, e.g. diverticulitis. We hypothesize that there exists a subgroup of patients with identifiable risk factors undergoing resection for diverticulitis that has relatively higher risks for VTE. We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Project database from 2006 to 2017 who underwent colorectal resection for diverticulitis. Patients with a primary indication for resection other than diverticulitis were excluded. Multivariate logistic regression modeling was conducted to determine the risk of VTE for each independent variable. A novel scoring system was developed and a receiver-operating-characteristic curve was generated. The rate of VTE was 1.49%. An 7-point scoring system was developed using identified significant variables. Patients scoring ≥ 6 on the developed scoring scale had a 3.12% risk of 30-day VTE development. A simple scoring system based on identified significant risk factors was specifically developed to predict the risk of VTE in patients undergoing diverticular colorectal resection. These patients are at significantly higher risk and may justify increased vigilance regarding VTE events, similar to patients undergoing colorectal resection for cancer or inflammatory bowel disease.
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Affiliation(s)
- Constantine M Poulos
- Department of Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA.
| | - Ashley L Althoff
- Department of Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Rachel B Scott
- Colon and Rectal Surgeons of Greater Hartford, Bloomfield, CT, 06002, USA
| | - Dorothy Wakefield
- Department of Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Robert Lewis
- Colon and Rectal Surgeons of Greater Hartford, Bloomfield, CT, 06002, USA
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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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Jiang K, Chen B, Lou D, Zhang M, Shi Y, Dai W, Shen J, Zhou B, Hu J. Systematic review and meta-analysis: association between obesity/overweight and surgical complications in IBD. Int J Colorectal Dis 2022; 37:1485-1496. [PMID: 35641579 PMCID: PMC9262757 DOI: 10.1007/s00384-022-04190-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE While the prevalence of obesity in inflammatory bowel disease (IBD) patients is rapidly increasing, it is unclear whether obesity affects surgical outcomes in this population. This meta-analysis aims to assess the impact of obesity/overweight on patients undergoing surgery for IBD. METHODS Databases (PubMed, Web of Science, Cochrane Library, and Springer) were searched through September 2021. The meta-analysis included patients with surgically treated IBD to investigate the impact of obesity/overweight on this population. Primary outcomes included overall complications, infectious complications, noninfectious complications, and conversion to laparotomy. RESULTS Fifteen studies totaling 12,622 IBD patients were enrolled. Compared with nonobese (including overweight) patients, obese IBD patients have increased the risk in terms of overall complications (OR = 1.45, p < 0.001), infectious complications (OR = 1.48, p = 0.003) (especially wound complications), as well as conversion to laparotomy (OR = 1.90, p < 0.001). Among the noninfectious complications, only the incidence of visceral injury (OR = 2.36, p = 0.05) had significantly increased. Compared with non-overweight patients, the risk of developing wound complications (OR = 1.65, p = 0.01) and sepsis (OR = 1.73, p = 0.007) were increased in overweight patients, but the rates of overall complications (OR = 1.04, p = 0.81), infectious complications (OR = 1.31, p = 0.07), and conversion to laparotomy (OR = 1.33, p = 0.08) associated with body mass index (BMI) were not significantly different. CONCLUSION Obesity is a risk factor for surgical complications in IBD patients, mainly reflected in infectious complications. Moreover, obese patients seem to have a more common chance of developing surgical complications than overweight patients.
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Affiliation(s)
- Ke Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bangsheng Chen
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Dandi Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jingyi Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bin Zhou
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Jinxing Hu
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences, Haishu District, Northwest Street 41, Ningbo, 315010, Zhejiang, China.
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13
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Luo J, Singh D, Zhang F, Yang X, Zha X, Jiang H, Yang L, Yang H. Comparison of the extraperitoneal and transperitoneal routes for permanent colostomy: a meta-analysis with RCTs and systematic review. World J Surg Oncol 2022; 20:82. [PMID: 35279174 PMCID: PMC8918274 DOI: 10.1186/s12957-022-02547-9] [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: 08/29/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Aim To assess the efficacy of extraperitoneal colostomy (EPC) in preventing stoma-related complications. Background Transperitoneal colostomy (TPC) is a widely used surgical approach. However, TPCs have been reported to have increased risks of stoma-related complications, such as parastomal hernias, stomal retraction, and stomal prolapse. The purpose of EPC is to reduce these complications. However, there is still a lack of evidence-based studies. Materials and methods MEDLINE, EMBASE, Web of Science, Scopus, MOOSE, PubMed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. The meta-analysis was performed with RevMan 5.4 software. Results This study included 5 eligible RCTs. Compared with the TPC group, the EPC group had lower incidence rates of parastomal hernias (RR, 0.14; 95% CI, 0.04–0.52, P = 0.003, I2 = 0%) and stomatal prolapse (RR, 0.27; 95% CI, 0.08–0.95, P = 0.04, I2 = 0%), but a higher rate of defecation sensation (RR, 3.51; 95% CI, 2.47–5.0, P < 0.00001, I2 = 37%). No statistically significant differences were observed in stoma retraction, colostomy construction time, stoma ischemia, or stoma necrosis. Conclusion Extraperitoneal colostomies are associated with lower rates of postoperative complications than transperitoneal colostomies. A randomized controlled trial meta-analysis found that permanent colostomies after abdominoperineal resection resulted in better outcomes.
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14
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Nitsche LJ, Mukherjee S, Cheruvu K, Krabak C, Rachala R, Ratnakaram K, Sharma P, Singh M, Yendamuri S. Exploring the Impact of the Obesity Paradox on Lung Cancer and Other Malignancies. Cancers (Basel) 2022; 14:cancers14061440. [PMID: 35326592 PMCID: PMC8946288 DOI: 10.3390/cancers14061440] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Studies have shown that obesity is associated with many adverse health effects, including worse cancer outcomes. Many studies paradoxically suggest a survival benefit for obesity in treatment outcomes of cancers such as non-small-cell lung cancer. This relationship is not seen in animal models. We hypothesize that this relationship is secondary to suboptimal quantification of adiposity, enhanced immunotherapy response, and variables such as sex, medications, and smoking status. There are many ways to measure and classify adiposity, but the ability to distinguish abdominal obesity is likely key in predicting accurate prognosis. There are many ways obesity impacts cancer treatment course from diagnosis to survivorship. In this paper, we aim to analyze the factors contributing to the obesity paradox and its effect on lung cancer. This can aid the treatment and prognosis of lung cancer and may support further research into obesity-specific impacts on this malignancy. Abstract There is a paradoxical relationship between obesity, as measured by BMI, and many types of cancer, including non-small-cell lung cancer. Obese non-small-cell lung cancer patients have been shown to fare better than their non-obese counterparts. To analyze the multifaceted effects of obesity on oncologic outcomes, we reviewed the literature on the obesity paradox, methods to measure adiposity, the obesity-related derangements in immunology and metabolism, and the oncologic impact of confounding variables such as gender, smoking, and concomitant medications such as statins and metformin. We analyzed how these aspects may contribute to the obesity paradox and cancer outcomes with a focus on lung cancer. We concluded that the use of BMI to measure adiposity is limited and should be replaced by a method that can differentiate abdominal obesity. We also concluded that the concomitant metabolic and immunologic derangements caused by obesity contribute to the obesity paradox. Medications, gender, and smoking are additional variables that impact oncologic outcomes, and further research needs to be performed to solidify the mechanisms.
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Affiliation(s)
- Lindsay Joyce Nitsche
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Sarbajit Mukherjee
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA;
| | - Kareena Cheruvu
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Cathleen Krabak
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Rohit Rachala
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Kalyan Ratnakaram
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Priyanka Sharma
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Maddy Singh
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; (L.J.N.); (K.C.); (C.K.); (R.R.); (K.R.); (P.S.); (M.S.)
- Correspondence: ; Tel.: +1-716-8458675
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15
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Watanabe J, Ishibe A, Ohya H, Suwa Y, Suwa H, Kunisaki C, Endo I. Evaluating the Effect of Intraoperative Near-Infrared Observation on Anastomotic Leakage After Stapled Side-to-Side Anastomosis in Colon Cancer Surgery Using Propensity Score Matching. Dis Colon Rectum 2021; 64:1542-1550. [PMID: 33661231 DOI: 10.1097/dcr.0000000000001960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recent studies have clarified that near-infrared observation using indocyanine green has the advantage of evaluating perfusion of the anastomotic site, especially in rectal cancer surgery, resulting in a reduction in anastomotic leak. OBJECTIVE The aim of this study was to evaluate the efficacy of near-infrared observation for reducing the anastomotic leak after stapled side-to-side anastomosis in colon cancer surgery. DESIGN This was a retrospective propensity score case-matched study. SETTINGS The study was conducted at 3 institutions in the Yokohama Clinical Oncology Group. PATIENTS From January 2011 to December 2019, patients who underwent colon cancer surgery with stapled side-to-side anastomosis were included. MAIN OUTCOME MEASURES The main outcome was the percentage of anastomotic leak within 30 days after surgery. RESULTS A total of 1034 patients were collected. There were 532 patients who underwent near-infrared observation and 502 who did not. A total of 370 patients were matched to the near-infrared and non-near-infrared groups. In the near-infrared group, 12 patients (3.2%) were judged to have poor perfusion (4 patients) and no perfusion (8 patients), so the planned transection point was changed. There were no cases of anastomotic leak among these 12 patients. The anastomotic leak rates were 3.5% (13/370) in the non-near-infrared group and 0.8% (3/370) in the near-infrared group. The anastomotic leak and reoperation rates were significantly lower in the near-infrared group than in the non-near-infrared group (OR, 0.224; 95% CI, 0.063-0.794, p = 0.001; OR, 0.348; 95% CI, 0.124-0.977, p = 0.036). LIMITATIONS Although we reduced selection bias by performing propensity score matching, this was a retrospective study and was not randomized. CONCLUSION This large-scale case-matched study showed that assessing perfusion by near-infrared observation significantly reduced the anastomotic leak and reoperation rates after stapled side-to-side anastomosis in colon cancer surgery and may be better suited to colo-colonic anastomosis. Video Abstract at http://links.lww.com/DCR/B513.Japanese Clinical Trials Registry: UMIN-CTR000039977. EVALUACIN DEL EFECTO DE LA OBSERVACIN INTRAOPERATORIA CON INFRARROJO CERCANO SOBRE LA FUGA ANASTOMTICA DESPUS DE UNA ANASTOMOSIS LATEROLATERAL CON ENGRAPADORA EN LA CIRUGA DE CNCER DE COLON MEDIANTE EL EMPAREJAMIENTO POR PUNTAJES DE PROPENSIN ANTECEDENTES:Estudios recientes han aclarado que la observación con infrarrojo cercano con verde de indocianina tiene la ventaja de evaluar la perfusión del sitio anastomótico, especialmente en la cirugía de cáncer de recto, lo que resulta en una reducción de la fuga anastomótica.OBJETIVO:El objetivo de este estudio fue evaluar la eficacia de la observación con infrarrojo cercano para reducir la fuga anastomótica después de una anastomosis latero-lateral con engrapadora en la cirugía de cáncer de colon.DISEÑO:Este fue un estudio retrospectivo emparejado con puntaje de propensión.AJUSTE:El estudio se llevó a cabo en tres instituciones del Grupo de Oncología Clínica de Yokohama.PACIENTES:Desde enero de 2011 hasta diciembre de 2019, se incluyeron pacientes que se sometieron a cirugía de cáncer de colon con anastomosis latero-lateral con engrapadora.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue el porcentaje de fuga anastomótica dentro de los 30 días posteriores a la cirugía.RESULTADOS:Se recogió un total de 1034 pacientes. Hubo 532 pacientes que se sometieron a observación con infrarrojo cercano y 502 que no. Un total de 370 pacientes fueron emparejados con los grupos de infrarrojo cercano y no infrarrojo cercano. En el grupo de infrarrojo cercano, se consideró que 12 casos (3,2%) tenían mala perfusión (4 casos) y ninguna perfusión (8 casos), por lo que se cambió el punto de transección planificado. No hubo casos de fuga anastomótica entre estos 12 casos. Las tasas de fuga anastomótica fueron del 3,5% (13/370) en el grupo sin infrarrojo cercano y del 0,8% (3/370) en el grupo con infrarrojo cercano. Las tasas de fuga anastomótica y de reintervención fueron significativamente menores en el grupo con infrarrojo cercano que en el grupo sin infrarrojo cercano (razón de posibilidades 0,224, intervalo de confianza del 95% 0,063-0,794, p = 0,001; razón de posibilidades 0,348, intervalo de confianza del 95% 0,124 -0,977, p = 0,036, respectivamente).LIMITACIONES:Aunque se redujo el sesgo de selección al realizar el emparejamiento por puntaje de propensión, este fue un estudio retrospectivo y no fue aleatorio.CONCLUSIÓN:Este estudio de casos emparejados a gran escala demostró que la evaluación de la perfusión mediante la observación con infrarrojo cercano redujo significativamente la fuga anastomótica y las tasas de reintervención después de la anastomosis latero-lateral con engrapadora en la cirugía de cáncer de colon y puede ser más adecuada para la anastomosis colo-colónica. Consulte Video Resumen en http://links.lww.com/DCR/B513.Registro japonés de ensayos clínicos: UMIN-CTR000039977.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroki Ohya
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Suwa
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hirokazu Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Abstract
PURPOSE Anastomotic leak (AL) following colorectal cancer resection is associated with considerable morbidity and mortality with an impact on recurrence rates and survival. The impact of obesity on AL rates is debated. This meta-analysis aims to investigate the relationship between obesity and AL. METHODS A search was conducted of the PubMed/MEDLINE, and Web of Science databases and included studies were split into Western and Asian groups based on population-specific body mass index (BMI) ranges for obesity. A meta-analysis was performed to assess the impact of obesity on AL rate following colorectal cancer resection. RESULTS Two thousand three hundred and four articles were initially screened. Thirty-one studies totaling 32,953 patients were included. Patients with obesity had a statistically significant increase in AL rate in all Western and Asian study groups. However, this increase was only clinically significant in the rectal anastomotic subgroups-Western: 10.8% vs 8.4%, OR 1.57 (1.01-2.44) and Asian: 9.4% vs 7.4%, OR 1.58 (1.07-2.32). CONCLUSIONS The findings of this analysis confirm that obesity is a significant risk factor for anastomotic leak, particularly in rectal anastomoses. This effect is thought to be primarily mediated via technical difficulties of surgery although metabolic and immunological factors may also play a role. Obesity in patients undergoing restorative CRC resection should be discussed and considered as part of the pre-operative counselling.
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17
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He AQ, Li CQ, Zhang Q, Liu T, Liu J, Liu G. Visceral-to-Subcutaneous Fat Ratio Is a Potential Predictor of Postoperative Complications in Colorectal Cancer. Med Sci Monit 2021; 27:e930329. [PMID: 34099612 PMCID: PMC8196549 DOI: 10.12659/msm.930329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is one of the most common malignant tumors. Surgery is the primary treatment for CRC. Recent studies have shown that visceral-to-subcutaneous fat ratio (VSR) may be a potential indicator of risk. The aim of the present study was to determine whether VSR is a suitable predictor of the impact of postoperative complications in CRC. Material/Methods Clinical data from 129 patients were analyzed retrospectively. All patients underwent laparoscopic surgery for CRC. Preoperative imaging was used to quantify VSR. The primary outcome was 30-day postoperative complications. Multivariate logistic regression was used to determine the association between obesity indexes and postoperative complications. Results There were 129 patients who underwent primary resections of colorectal cancer. At 30 days after surgery, postoperative complications had occurred in 33 (25.6%) patients. VSR was significantly associated with postoperative complications in multivariate analysis (P=0.032, OR 6.103, 95% CI 1.173–31.748). In ROC analysis, VSR was a potential predictor of complications (AUC 0.650). A cutoff value of VSR ≥0.707 was associated with 60% sensitivity and 29% specificity for postoperative complications. Patients with VSR ≥0.707 had 41.7% risk of morbidity, whereas those with <0.707 had 16.0% risk (P=0.001). Conclusions Our study shows that VSR is superior to VFA for prediction of the risk of complications following CRC laparoscopic surgery. We have also identified the optimal cutoff values for the use of VSR for this purpose. Measurement of VSR and identifying patients with increased risk of postoperative complications facilitate making perioperative decisions.
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Affiliation(s)
- An-Qi He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Chun-Qiang Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Qi Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Tong Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Jian Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
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Bizzoca C, Zupo R, Aquilino F, Castellana F, Fiore F, Sardone R, Vincenti L. Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study. Cancers (Basel) 2021; 13:cancers13081844. [PMID: 33924366 PMCID: PMC8069288 DOI: 10.3390/cancers13081844] [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] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Extended evidence on minimally invasive surgery in colorectal cancer (CRC) settings is needed, especially as applied to obese patients. We aimed to explore and compare postoperative outcomes between open and video-laparoscopic (VL) surgery in two groups of obese patients undergoing surgical resection for CRC. VL surgery was found to reduce postoperative recovery time and the severity of complications. This Italian experience provides a further contribution to the short-term prognostic quality of minimally invasive VL surgery in obese patients. Abstract Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery.
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Affiliation(s)
- Cinzia Bizzoca
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
- Correspondence: or
| | - Roberta Zupo
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Fabrizio Aquilino
- General Surgery Unit, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy;
| | - Fabio Castellana
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Felicia Fiore
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Leonardo Vincenti
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
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19
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Choi D, Hendren S, Chang MI, Abunayla A, Battaglia MA, Cleary RK. The impact of obesity and morbid obesity on urgent/emergency colorectal resections: a regional database analysis. Surg Endosc 2021; 36:1876-1886. [PMID: 33825018 DOI: 10.1007/s00464-021-08467-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The obesity rate is projected to reach 50% by 2030. Obesity may be modifiable prior to elective colorectal surgery, but there is no opportunity for weight loss when patients present for urgent/emergency operations. The impact of obesity focused on urgent/emergent colorectal operations has not been fully characterized. The study aim was to determine outcomes of obese patients who undergo urgent/emergency colorectal surgery and differences when compared with elective outcomes. METHODS This is a retrospective cohort study of 30-day outcomes for normal (BMI 18.5-25), obese (BMI 30-39.9), and morbidly obese (BMI > 40) patients in the Michigan Surgical Quality Collaborative between 1/1/2009 and 12/31/2018. Propensity score weighting was used to derive adjusted rates for overall morbidity, mortality, and specific complications. Primary outcome was postoperative complications (any morbidity). RESULTS The study included 5268 urgent/emergency and 10,414 elective colorectal surgery patients. Postoperative complications were significantly more common in morbidly obese and obese than the normal BMI group for both urgent/emergency (morbidly obese 42.76% vs 33.75%, p = 0.003; obese 36.46% vs 33.75%, p = 0.043) and elective (morbidly obese 18.17% vs 13.36%, p = 0.004; obese 15.45% vs 13.36%, p = 0.011) operations. Surgical site infections are were significantly more common in morbidly obese and obese BMI groups as compared to normal BMI for both urgent/emergency and elective cases. Mortality was significantly higher in the morbidly obese (14.93% vs 11.44%, p = 0.013) but not obese BMI groups as compared to the normal BMI group for urgent/emergency cases. Mortality for all groups undergoing elective operations was < 1% and with no significant differences. CONCLUSIONS Morbid obesity and obesity are associated with complications that are largely driven by surgical site infections after both urgent/emergency and elective colorectal surgery. Obesity is a risk factor difficult to modify prior to urgent/emergency surgery. Managing complications related to obesity after colorectal surgery will be a continued challenge with projected increasing obesity rates.
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Affiliation(s)
- Dennis Choi
- Department of Surgery, St Joseph Mercy Hospital, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Samantha Hendren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Melissa I Chang
- Department of Surgery, St Joseph Mercy Hospital, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA
| | - Ali Abunayla
- Department of Academic Research, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Michael A Battaglia
- Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, 5325 Elliott Dr MHVI #104, Ann Arbor, MI, 48106, USA.
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20
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El-Dallal M, Stein DJ, Raita Y, Feuerstein JD. The impact of obesity on hospitalized patients with ulcerative colitis. Ann Gastroenterol 2021; 34:196-201. [PMID: 33654359 PMCID: PMC7903582 DOI: 10.20524/aog.2021.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022] Open
Abstract
Background Obesity is the fifth leading risk factor for mortality in the world and it has increased among patients with ulcerative colitis in recent years. We examined the impact of obesity on the hospitalized patients admitted primarily with a diagnosis of ulcerative colitis. Methods We used the National Inpatient Sample data for the year 2016 to identify patients with ulcerative colitis and compared obese and non-obese patients in terms of length of hospital stay, total charges, and mortality. We used multiple imputations to estimate missing values and survey analysis to estimate the outcomes, and we adjusted for confounders by implementing the inverse probability of treatment weighting using propensity score. Results A total of 61,075 admissions with ulcerative colitis were identified. Among these, 6020 were diagnosed with obesity. Baseline hospital and patient characteristics between the 2 groups were notable for differences in age and sex. Patients with obesity were found to have a mean hospital stay longer by 0.57 days (95% confidence interval [CI] 0.22-0.93; P=0.002) and charges $6341.71 higher (95%CI 2499.72-10,183.71; P=0.001) compared to non-obese patients. There was no difference in hospital mortality, with an odds ratio of 0.28 (95%CI 0.04-2.05; P=0.212). Conclusion In a comprehensive review of inpatient admissions in 2016, primarily for ulcerative colitis, obesity was associated with a longer hospital stay and higher total charges per admission after balancing of confounders.
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Affiliation(s)
- Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA (Mohammed El-Dallal).,Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
| | - Daniel J Stein
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Daniel J. Stein)
| | - Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Yoshihiko Raita), USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Mohammed El-Dallal, Joseph D. Feuerstein)
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21
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Ikeda A, Fukunaga Y, Akiyoshi T, Nagayama S, Nagasaki T, Yamaguchi T, Mukai T, Hiyoshi Y, Konishi T. Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases. Discov Oncol 2021; 12:2. [PMID: 33844707 PMCID: PMC7878211 DOI: 10.1007/s12672-021-00396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This prospective observational study aimed to clarify the incidence and independent risk factors of wound infection after laparoscopic surgery for primary colonic and rectal cancer. METHODS A prospective surveillance of surgical site infection (SSI) was conducted in consecutive patients with primary colorectal cancer, who underwent elective laparoscopic surgery in a single comprehensive cancer center between 2005 and 2014. The outcomes of interest were the incidence and risk factors of wound infection. RESULTS In total, 3170 patients were enrolled in the study. The overall incidence of wound infection was 3.0%. The incidence of wound infection was significantly higher in rectal surgery than in colonic surgery (4.7 vs. 2.1%, p < 0.001). In rectal surgery, independent risk factors for developing wound infection included abdominoperineal resection (p < 0.001, odds ratio [OR] = 11.4, 95% confidence interval [CI]: 5.04-24.8), body mass index (BMI) ≥ 25 kg/m2 (p = 0.041, OR = 1.97, 95% CI, 1.03-3.76), and chemoradiotherapy (p = 0.032, OR = 2.18, 95% CI, 1.07-4.45). In laparoscopic colonic surgery, no significant risk factors were identified. CONCLUSIONS Laparoscopic rectal surgery has a higher risk of wound infection than colonic surgery. Laparoscopic rectal surgery involving abdominoperineal resection, patients with higher BMI, and chemoradiotherapy requires careful observation in wound care and countermeasures against wound infection.
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Affiliation(s)
- Atsushi Ikeda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, 1400 Pressler Street Unit 1484, Houston, TX 77030 USA
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22
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Fu CY, Bajani F, Bokhari M, Tatebe LC, Starr F, Messer T, Kaminsky M, Dennis A, Schlanser V, Mis J, Toor R, Poulakidas S, Bokhari F. Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity-Matched Nationwide Cohort Study. World J Surg 2020; 44:755-763. [PMID: 31712846 PMCID: PMC7223826 DOI: 10.1007/s00268-019-05268-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction Obesity is associated with increased morbidity and mortality in abdominal trauma patients. The characteristics of abdominal trauma patients with poor outcomes related to obesity require evaluation. We hypothesize that obesity is related to increased mortality and length of stay (LOS) among abdominal trauma patients undergoing laparotomies. Methods Abdominal trauma patients were identified from the National Trauma Data Bank between 2013 and 2015. Patients who received laparotomies were analyzed using propensity score matching (PSM) to evaluate the mortality rate and LOS between obese and non-obese patients. Patients without laparotomies were analyzed as a control group using PSM cohort analysis. Results A total of 33,798 abdominal trauma patients were evaluated, 10,987 of them received laparotomies. Of these patients, the proportion of obesity in deceased patients was significantly higher when compared to the survivors (33.1% vs. 26.2%, p < 0.001). Elevation of one kg/m2 of body mass index independently resulted in 2.5% increased odds of mortality. After a well-balanced PSM, obese patients undergoing laparotomies had significantly higher mortality rates [3.7% vs. 2.4%, standardized difference (SD) = 0.241], longer hospital LOS (11.1 vs. 9.6 days, SD = 0.135), and longer intensive care unit LOS (3.5 vs. 2.3 days, SD = 0.171) than non-obese patients undergoing laparotomies. Conclusions Obesity is associated with increased mortality in abdominal trauma patients who received laparotomies versus those who did not. Obesity requires a careful evaluation of alternatives to laparotomy in injured patients. Electronic supplementary material The online version of this article (10.1007/s00268-019-05268-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyüan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Leah C. Tatebe
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Rubinder Toor
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
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23
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Chang YWW, Murphy K, Yackzan D, Thomas S, Kay D, Davenport D, Evers BM, Bhakta AS. Abdominal Wall Thickness is a Predictor for Surgical Site Infections in Patients Undergoing Colorectal Operations. Am Surg 2020; 87:1155-1162. [PMID: 33345564 DOI: 10.1177/0003134820956932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are an established complication following colorectal operations, with rates up to 30% reported in the literature. Obesity is a known risk factor for SSI; however, body mass index (BMI), body fat percentage, waist-hip ratio, or abdominal circumference are imperfect measures. The purpose of our study was to determine whether abdominal wall thickness (AWT) is predictive of SSI. METHODS We queried our American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database for patients (age ≥18 years) undergoing a colectomy at the University of Kentucky (UK) from January 1, 2013 to December 31, 2018. The exclusion criteria included patients with open abdomens or the lack of preoperative computed tomography (CT) within 3 months of their operation. AWT was measured at the level of the anterior superior iliac spine (ASIS) on abdominal CT. SSI was defined by superficial SSI, deep SSI, and wound dehiscence. RESULTS Of 1261 patients enrolled, 52.2% were female, with an average age of 57.4 years. More patients had laparoscopic operations (51%), and the median length of stay was 7 days. Our study demonstrated an SSI rate of 9.4% and a 30-day readmission rate of 11%. The overall mean AWT was 2.6 cm (range .1-13.1), and patients with the highest AWT quintile were more likely to develop an SSI than the lowest quintile (12% vs. 5%). After controlling for risk factors and confounders, the odds of an SSI were 3.6 times higher for patients with the highest AWT than patients with the lowest AWT. CONCLUSIONS Among colorectal surgery patients, AWT is an independent risk factor predictive for SSI.
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Affiliation(s)
- Yu-Wei W Chang
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA.,Markey Cancer Center, 12253University of Kentucky Medical Center, KY, USA
| | - Kyle Murphy
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA.,Markey Cancer Center, 12253University of Kentucky Medical Center, KY, USA
| | - Daniel Yackzan
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA
| | - Sarah Thomas
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA
| | - Danielle Kay
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA.,Markey Cancer Center, 12253University of Kentucky Medical Center, KY, USA
| | - Daniel Davenport
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA
| | - Bernard M Evers
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA.,Markey Cancer Center, 12253University of Kentucky Medical Center, KY, USA
| | - Avinash S Bhakta
- Department of Surgery, 12253University of Kentucky Medical Center, KY, USA.,Markey Cancer Center, 12253University of Kentucky Medical Center, KY, USA
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24
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Raman S, Gorvet M, Lange K, Rettenmaier N. Outcomes after CT guided drainage of diverticular abscesses and predictive factors for fistulous communication to the colon. Am J Surg 2020; 222:193-197. [PMID: 33059942 DOI: 10.1016/j.amjsurg.2020.10.010] [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: 08/02/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of the study is to analyze patient outcomes following CT guided drainage of colonic diverticular abscesses and identify the factors associated with development of fistulous communication to the drain. METHODS All patients undergoing CT guided abscess drainage, from 2009 to 2017, were included in this single institutional study. Clinical and demographic variables associated with development of colonic fistula were investigated. RESULTS One-hundred-and-five patients (55% female), mean abscess size and BMI of 6.3 cm and 30.28 kg/m2, respectively, underwent CT guided abscess drainage. Patients with fistula had longer operative times (p = 0.03). On multivariable analysis, females (p = 0.02) and higher BMI (p = 0.01) were protective against, while increasing size (p = 0.01) was predictive of developing fistulous communication to the drain. CONCLUSION More than half of patients developed colonic fistula after CT guided drainage. Male sex, lower BMI and increasing abscess size were predictive of developing colonic fistula.
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Affiliation(s)
- Shankar Raman
- MercyOne Des Moines Medical Center, 1111 6th Ave., Des Moines, IA, 50314, USA.
| | - Marc Gorvet
- MercyOne Des Moines Medical Center, 1111 6th Ave., Des Moines, IA, 50314, USA.
| | - Krystle Lange
- MercyOne Des Moines Medical Center, 1111 6th Ave., Des Moines, IA, 50313, USA.
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25
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum 2020; 63:1191-1222. [PMID: 33216491 DOI: 10.1097/dcr.0000000000001762] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Giani A, Famularo S, Riva L, Tamini N, Ippolito D, Nespoli L, Conconi P, Sironi S, Braga M, Gianotti L. Association between specific presurgical anthropometric indexes and morbidity in patients undergoing rectal cancer resection. Nutrition 2020; 75-76:110779. [PMID: 32268263 DOI: 10.1016/j.nut.2020.110779] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Baseline body composition has been associated with dismal outcomes in patients undergoing a variety of major abdominal operations. Whether specific anthropometric indexes can predict morbidity after rectal resection has been poorly investigated. The aims of this study were to assess whether there is a relationship between body mass index and the different computed tomography-assessed body composition indexes, and whether the analysis of different body compartments could be predictive of short-term outcomes in patients undergoing curative surgery for rectal cancer. METHODS Computed tomography-derived measures of skeletal muscle and adipose tissue areas of patients undergoing surgery for rectal cancer between January 2009 and December 2016 were used to calculate population-specific thresholds of sarcopenia, subcutaneous adiposity, visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. Association between the aforementioned body composition features were related with overall complication, infection, and anastomotic leak. RESULTS During the study period, 311 patients received surgery and 173 were eligible for an accessible preoperative computed tomography imaging. After surgery, 59 (34.1%) patients experienced a complication, 29 an infection, and 10 an anastomotic failure. The overall morbidity rate was observed more frequently in patients with sarcopenia than in those without sarcopenia (39% versus 17.5%; P = 0.002) and infections (41.4% versus 21.5% respectively; P = 0.024). The presence of myosteatosis also was associated with a higher incidence of overall morbidity (33.9% versus 20.2% in patients without myoteatosis; P = 0.048). Anastomotic failure occurred in 6 of 10 patients with visceral obesity and in 24 of 112 (21.4%) patients without this condition (P = 0.007). CONCLUSIONS Some anthropometric indexes are accurate predictors of specific types of morbidity. These findings may allow a more accurate preoperative risk stratification.
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Affiliation(s)
- Alessandro Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Riva
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | | | - Luca Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Paola Conconi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Surgery, San Gerardo Hospital, Monza, Italy.
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27
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Galmarini CM. Lessons from Hippocrates: Time to Change the Cancer Paradigm. Int J Chronic Dis 2020; 2020:4715426. [PMID: 32566644 PMCID: PMC7298279 DOI: 10.1155/2020/4715426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 01/02/2023] Open
Abstract
The ultimate goal of all medical activity is to restore patients to a state of complete physical, mental, and social wellbeing. In cancer, it is assumed that this can only be obtained through the complete eradication of the tumor burden. So far, this strategy has led to a substantial improvement in cancer survival rates. Despite this, more than 9 million people die from cancer every year. Therefore, we need to accept that our current cancer treatment paradigm is obsolete and must be changed. The new paradigm should reflect that cancer is a systemic disease, which affects an individual patient living in a particular social reality, rather than an invading organism or a mere cluster of mutated cells that need to be eradicated. This Hippocratic holistic view will ultimately lead to an improvement in health and wellbeing in cancer patients. They deserve nothing less.
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Affiliation(s)
- Carlos M. Galmarini
- Topazium Artificial Intelligence, Paseo de la Castellana 40, 28046 Madrid, Spain
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28
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Fu CY, Bajani F, Bokhari M, Butler C, Starr F, Messer T, Kaminsky M, Tatebe LC, Dennis A, Schlanser V, Poulakidas S, Cheng CT, Toor R, Mis J, Bokhari F. Obesity May Require a Higher Level of Trauma Care: A Propensity-Matched Nationwide Cohort Study. PREHOSP EMERG CARE 2020; 25:361-369. [PMID: 32286928 DOI: 10.1080/10903127.2020.1755754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Methods: Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. Results: 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, p < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, p < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
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29
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Turner GA, O'Grady M, Frizelle FA, Eglinton TW, Sharma PV. Influence of obesity on the risk of recurrent acute diverticulitis. ANZ J Surg 2020; 90:2032-2035. [PMID: 32129575 DOI: 10.1111/ans.15784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute diverticulitis (AD) is a common surgical problem with increasing incidence. Obesity has become epidemic in western countries. Obesity has been shown to increase the risk of developing AD; however, little is known about its influence on the risk of recurrence. The decision to perform elective surgical resection to reduce the risk of recurrent AD is made on an individual basis considering perceived risk of recurrence weighed against patient comorbidity. The aim of this study is to assess whether obesity affects the likelihood of developing recurrent AD. METHODS A retrospective audit was conducted of all admissions with AD to a tertiary centre between 1998 and 2010. Medical records were reviewed and patients with an index presentation with AD included in the analysis. Imaging was used to calculate body mass index (BMI) for assessment of obesity. Follow-up was for a minimum of 3 years from admission. RESULTS A total of 1299 patients were admitted with an index presentation of AD in the study period. 18.3% overall had recurrent AD, all of whom had confirmation on imaging. Computed tomography was used to calculate BMI in 849 patients, of whom 470 (55.4%) were considered obese (BMI >30). The likelihood of recurrent AD was not significantly different in obese patients compared to their non-obese counterparts (P = 0.2473). CONCLUSION While obesity increases the risk of developing AD overall, it does not appear to increase the likelihood of developing recurrent AD. This has implications for risk stratification when considering surgical resection to prevent recurrent AD.
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Affiliation(s)
- Greg A Turner
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Michael O'Grady
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Frank A Frizelle
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Tim W Eglinton
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Prashant V Sharma
- Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
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Weber KT, Chung PJ, La Gamma N, Procaccino JA, Alfonso AE, Coppa G, Sugiyama G. Effect of Body Mass Index on Outcomes After Surgery for Perforated Diverticulitis. J Surg Res 2020; 247:220-226. [DOI: 10.1016/j.jss.2019.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/15/2019] [Accepted: 10/01/2019] [Indexed: 01/26/2023]
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Serra-Aracil X, Gil-Barrionuevo E, Lobato-Gil R, Gonzalez-Costa A, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Navarro-Soto S. Is obesity a factor of surgical difficulty in transanal endoscopic surgery? Am J Surg 2020; 220:687-692. [PMID: 31983409 DOI: 10.1016/j.amjsurg.2020.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients. METHODS Observational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) < 30 kg/m2 and BMI ≥30 kg/m2, the latter defined as obese. RESULTS From 775 patients, 681 were enrolled in the study, 145 (21.3%) of them obese. No statistically significant differences between groups were found with respect to overall morbidity (27, 18.6%).The obese patients presented trends towards shorter mean surgical time (65 min, IQR 48 min), less perforation in the peritoneal cavity (eight, 5.5%), and 133 (91.7%) presented a lower rate of lesion fragmentation. CONCLUSION There were no significant differences in postoperative outcomes in obese patients (BMI ≥30 kg/m2). TES in those obese patients does not represent a factor of surgical difficulty.
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Affiliation(s)
- Xavier Serra-Aracil
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain.
| | - Esther Gil-Barrionuevo
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Raquel Lobato-Gil
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Anna Gonzalez-Costa
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Laura Mora-López
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Anna Pallisera-Lloveras
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Sheila Serra-Pla
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Salvador Navarro-Soto
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
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Larg A, Moss JR, Spurrier N. Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia. AUST HEALTH REV 2019; 43:148-156. [PMID: 29467071 DOI: 10.1071/ah17147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
Objective Arguments to fund obesity prevention have often focused on the growing hospital costs of associated diseases. However, the relative contribution of overweight and obesity to public hospital expenditure growth is not well understood. This paper examines the effect of overweight and obesity on acute public hospital in-patient expenditure in South Australia over time compared with other expenditure drivers. Methods Annual inflation-adjusted acute public admitted expenditure attributable to a high body mass index was estimated for 2007-08 and 2011-12 and compared with other expenditure drivers. Results Expenditure attributable to overweight and obesity increased by A$45million, from 4.7% to 5.4% of total acute public in-patient expenditure. This increase accounted for 7.8% of the A$583million total expenditure growth, whereas the largest component of total growth (62.4%) was a real increase in the average cost per separation. Conclusions The relatively minor contribution of overweight and obesity to expenditure growth over the time period examined invites reflection on arguments to boost preventive spending that centre upon reducing hospital costs. These arguments may inadvertently detract attention from the considerable health and social burdens of overweight and obesity and from unrelated sources of expenditure growth that reduce opportunities for state governments to fund obesity prevention programs despite their comparative benefits to population health. What is known about the topic? Stand-alone estimates suggest that overweight and obesity are placing a considerable financial burden on the Australian public healthcare system. What does this paper add? Our findings challenge common perceptions about the relative importance of overweight and obesity in the context of rising public in-patient expenditure in Australia. What are the implications for practitioners? Consistent serial estimates of overweight- and obesity-attributable expenditure enable its tracking and comparison with other potentially controllable expenditure drivers that may also warrant attention. Explicit consideration of population health trade-offs in expenditure-related decisions, including in enterprise bargaining, would enhance transparency in priority setting.
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Affiliation(s)
- Allison Larg
- Central Adelaide Local Health Network, Royal Adelaide Hospital, 130/136 North Terrace, Adelaide, SA 5000, Australia
| | - John R Moss
- The University of Adelaide, School of Public Health, North Terrace, Adelaide, SA 5000, Australia. Email
| | - Nicola Spurrier
- Public Health Services, SA Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia. Email
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Bell S, Malouf P, Johnson N, Wale R, Peng Q, Nottle P, Warrier S. Pelvic fat volume reduction with preoperative very low energy diet (VLED): implications for rectal cancer surgery in the obese. Tech Coloproctol 2019; 23:887-892. [PMID: 31485770 DOI: 10.1007/s10151-019-02074-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Obese patients have higher complication rates after pelvic surgery. Laparoscopic rectal surgery may not be possible in the obese individual due to mesorectal, total pelvic and general visceral fat volumes. Very low energy diets reduce visceral fat but the changes within the pelvis and mesorectum are unknown. The aim of the present study was to quantify the proportion of fat lost from total pelvic and mesorectal fat with a very low energy diet (VLED) and define simple, accessible measurements that correlate with expected volume reduction. METHODS A study was conducted on proportion change in mesorectal and intrapelvic fat volumes in patients on a VLED prior to bariatric surgery at the Alfred Hospital in Melbourne. The VLED was a standardized 4-week meal replacement. Proportion change in mesorectal and intrapelvic fat volumes were measured. Patients had standardized pre-diet and post-diet magnetic resonance imaging (MRI) of the pelvis. Body mass index, weight and girth measures were obtained. Adipose quantification analysis was performed using Q-Fat. RESULTS Nine patients were included in this study, who were preparing for bariatric (not colorectal) surgery (5 females, median age 42 years, range 27-59 years) pre-protocol body mass index was 55.8 (range 39.5-60.6 kg/m2); median weight was 163 kg. Median mesorectal fat reduction was 29.9% (range 11.6-66.6%). Linear regression showed a relationship between the amount of mesorectal fat reduction and two variables: patient height and the distance from S1 to the posterior aspect of the rectum on MRI. The relationship predicted response to the diet (R2 67%, p = 0.040). CONCLUSIONS Very low energy diets result in a clinically significant reduction in mesorectal fat with a lesser change in total pelvic fat, suggesting that very low energy diets may be useful for preparation for pelvic surgery in the obese. The distance from S1 to the posterior rectum correlates well with mesorectal reduction, making this a valuable clinical tool when volumetric analysis is not possible. This analysis is limited to the quantification of the effect of the diet and cannot comment on the safety of this approach before pelvic cancer surgery.
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Affiliation(s)
- S Bell
- Cabrini-Monash University Department of Surgery, Cabrini Hospital, Suite 27 Cabrini Medical Centre, Isabella St, Malvern, VIC, 3144, Australia.
| | - P Malouf
- Department of Colorectal Surgery, Sutherland Hospital, University of New South Wales, Sydney, NSW, Australia
| | - N Johnson
- Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | - R Wale
- Cabrini-Monash University Department of Surgery, Cabrini Hospital, Suite 27 Cabrini Medical Centre, Isabella St, Malvern, VIC, 3144, Australia
| | - Q Peng
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - P Nottle
- Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | - S Warrier
- Cabrini-Monash University Department of Surgery, Cabrini Hospital, Suite 27 Cabrini Medical Centre, Isabella St, Malvern, VIC, 3144, Australia
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Jehan F, Zeeshan M, Con J, Hanna K, Tang A, Hamidi M, Latifi R, Joseph B. Metabolic Syndrome Exponentially Increases the Risk of Adverse Outcomes in Operative Diverticulitis. J Surg Res 2019; 245:544-551. [PMID: 31470335 DOI: 10.1016/j.jss.2019.07.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is defined as the cluster: hypertension, obesity, and diabetes. Operative diverticulitis in the setting of MS can be challenging to manage. The aim of our study was to evaluate the impact of MS on outcomes in operative acute diverticulitis patients. METHODS We analyzed the (2012-2015) NSQIP database. We identified acute diverticulitis patients who underwent surgery. MS was defined as follows: body mass index (BMI) >30 kg/m2, hypertension, and diabetes. Our primary outcome measure was the occurrence of any adverse events (complications, 30-d readmission, and mortality). Secondary outcome measures were complications, hospital length of stay, 30-d readmission, and mortality. Regression and receiver operating characteristic curve analysis was performed. RESULTS A total of 4572 patients were identified. Mean BMI was 29 ± 10 kg/m2. 14.6% (275) of obese patients had metabolic syndrome. Adverse events were higher in patients with MS (odds ratio [OR], 8.1; P < 0.001) versus the obese group and the obese and hypertensive group. Patients with MS had higher odds of reintubation (OR 1.9; P = 0.03), >48 h ventilator dependence (OR 3.5; P = 0.01), myocardial infarction (OR 2.3; P = 0.03), and superficial or deep surgical-site infections (OR 2.1; P = 0.01) compared with patients with no MS. MS patients had a longer length of stay (β = 1.23; P = 0.02), higher 30-d readmissions (OR 1.7; P < 0.01), and mortality (OR 2.1; P < 0.01). The area under the receiver operating characteristic curve of metabolic syndrome for predicting adverse outcomes was 0.797, which was higher than the area under the receiver operating characteristic curve for BMI (0.58), hypertension (0.51), or diabetes (0.64) alone. CONCLUSIONS Adverse events in patients with MS after surgery for diverticulitis are higher than obesity, hypertension, or diabetes alone. Patients with MS have longer recovery, and higher rates of complications, readmissions, and mortality. LEVEL OF EVIDENCE Level III Prognostic.
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Affiliation(s)
- Faisal Jehan
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Jorge Con
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mohammad Hamidi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Fu CY, Bajani F, Butler C, Welsh S, Messer T, Kaminsky M, Starr F, Dennis A, Schlanser V, Mis J, Poulakidas S, Bokhari F. Morbid Obesity's Silver Lining: An Armor for Hollow Viscus in Blunt Abdominal Trauma. World J Surg 2019; 43:1007-1013. [PMID: 30478685 DOI: 10.1007/s00268-018-4872-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Morbid obesity is usually accompanied by both subcutaneous and visceral fat accumulation. Fat can mimic an air bag, absorbing the force of a collision. We hypothesized that morbid obesity is mechanically protective for hollow viscus organs in blunt abdominal trauma (BAT). METHODS The National Trauma Data Bank (NTDB) was queried for BAT patients from 2013 to 2015. We looked at the rate of gastrointestinal (GI) tract injuries in all BAT patients with different BMIs. A subset analysis of BAT patients with operative GI tract injuries was performed to evaluate the need for abdominal operation. Multivariate analyses were carried out to identify factors independently associated with increased GI tract injuries and associated abdominal operations. RESULTS A total of 100,459 BAT patients were evaluated in the NTDB. Patients with GI tract injury had a lower proportion of morbidly obese patients [body weight index (BMI) ≥ 40 kg/m2)] (3.7% vs. 4.2%, p = 0.015) and instead had more underweight patients (BMI < 18.5) (5.9% vs. 5.0%, p < 0.001). The risk of GI tract injury decreased 11.6% independently in morbidly obese patients and increased 15.7% in underweight patients. Of the patients with GI tract injuries (N = 11,467), patients who needed a GI operation had a significantly lower proportion of morbidly obese patients (3.2% vs. 5.3%, p < 0.001). The risk of abdominal operation for GI tract injury decreased 57.3% independently in morbidly obese patients. Compared with underweight patients, morbidly obese patients had significantly less GI tract injury (6.0% vs. 13.3%, p < 0.001) and associated abdominal operation rates (65.2% vs. 73.3%, p < 0.001). CONCLUSION Obesity is protective in BAT. This translates into lower rates of GI tract injury and operation in morbidly obese patients. In contrast, underweight patients appear to suffer a higher rate of GI tract injury and associated GI operations.
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Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA.,Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Caroline Butler
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Stanley Welsh
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA.
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Abstract
Complications after colorectal surgery are common. Given the frequency of postoperative complications and their implications on quality of life, it is important to know how to predict and prevent the complications that we encounter. This article aims to provide ways to predict and prevent postoperative complications in colorectal surgery. Here, we review the predictive models, American College of Surgeons National Surgery Quality Improvement Program risk calculator and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity on their practicality and usefulness. Additionally, this review summarizes nonmodifiable and modifiable risk factors in colorectal surgery, which are important for surgeons to understand to minimize and attempt to avoid postoperative complications as well as providing ways to optimize patients preoperatively. Thus, this review will provide information to surgeons to predict and prevent postoperative complications, how to optimize patients preoperatively and ultimately to help reduce their occurrence.
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Affiliation(s)
- Sung Gon Lee
- Department of Surgery, University of Tennessee Graduate School of Medicine, The University of Tennessee Medical Center, Knoxville, Tennessee
| | - Andrew Russ
- Department of Surgery, University of Tennessee Graduate School of Medicine, The University of Tennessee Medical Center, Knoxville, Tennessee
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Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc 2019; 34:202-208. [PMID: 30877565 DOI: 10.1007/s00464-019-06751-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have shown the potential benefit of indocyanine green fluorescence imaging (ICG-FI) in lowering the anastomotic leakage (AL) rates by changing the surgical plan. The aim of this study was to evaluate the effect of ICG-FI on the AL rates in laparoscopic low anterior resection (LAR) for rectal cancer. METHODS From September 2014 to December 2017, data from patients who underwent laparoscopic LAR for rectal cancer were collected and analyzed. The primary endpoint was the AL rate within 30 days after surgery. The incidence of AL in patients who underwent ICG (ICG-FI group) was compared with that in patients who did not undergo ICG (non-ICG-FI group) using propensity score matching. RESULTS Data from 550 patients were collected from 3 institutions. A total of 211 patients were matched in both groups by the propensity score. ICG-FI shifted the point of the proximal colon transection line toward the oral side in 12 patients (5.7%). The AL rates of Clavien-Dindo (CD) grade ≥ II and ≥ III were 10.4% (22/211) and 9.5% (20/211) in the non-ICG-FI group and 4.7% (10/211) and 2.8% (6/211) in the ICG-FI group, respectively. ICG-FI significantly reduced the AL rate of CD grade ≥ II and ≥ III (odds ratio (OR) 0.427; 95% confidence interval (CI) 0.197-0.926; p = 0.042 and OR 0.280; CI 0.110-0.711; p = 0.007, respectively). The rate of reoperation was significantly lower (OR 0.192; CI 0.042-0.889; p = 0.036) and the postoperative hospital stay significantly shorter (mean difference 2.62 days; CI 0.96-4.28; p = 0.002) in the ICG-FI group than in the non-ICG-FI group. CONCLUSIONS ICG-FI was associated with significantly lower odds of AL in laparoscopic LAR for rectal cancer. CLINICAL TRIAL The study was registered with the Japanese Clinical Trials Registry as UMIN000032654.
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Liu Y, Kongsuphol P, Chiam SY, Zhang QX, Gourikutty SBN, Saha S, Biswas SK, Ramadan Q. Adipose-on-a-chip: a dynamic microphysiological in vitro model of the human adipose for immune-metabolic analysis in type II diabetes. LAB ON A CHIP 2019; 19:241-253. [PMID: 30566152 DOI: 10.1039/c8lc00481a] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Infiltration of immune cells into adipose tissue is associated with chronic low-grade inflammation in obese individuals. To better understand the crosstalk between immune cells and adipocytes, in vivo-like in vitro models are required. Conventionally transwell culture plates are used for studying the adipocyte-immune cell interaction; however, the static culture nature of this approach falls short of closely recapitulating the physiological environment. Here we present a compartmentalized microfluidic co-culture system which provides a constant-rate of nutrient supply as well as waste removal, resembling the microvascular networks of the in vivo environment. Human adipocytes and U937 cells were co-cultured in close proximity in an enclosed system. The porous barrier between the adjacent compartments comprises an array of microchannels, which enables paracrine interaction between cells in adjacent compartments and improved perfusion-based long term cell feeding. Human pre-adipocytes were fully differentiated into adipocytes on the chip and remained viable for several weeks. Upon co-culturing with immune cells, adipocytes showed a tendency to develop insulin resistance. The immune-metabolic correlation has been studied by monitoring adiponectin and IL-6 expression, as well as glucose uptake upon treatment with insulin. Our microfluidic system can be potentially used to develop physiologically relevant adipose tissue models to study obesity-associated diseases such as insulin resistance and type 2 diabetes and therefore, facilitate drug development to treat these diseases.
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Affiliation(s)
- Yunxiao Liu
- Institute of Microelectronic, A* STAR (Agency for Science, Technology and Research), 2, Fusionopolis Way, #08-02, Innovis Tower, 138635 Singapore.
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Arkenbosch JHC, van Erning FN, Rutten HJ, Zimmerman D, de Wilt JHW, Beijer S. The association between body mass index and postoperative complications, 30-day mortality and long-term survival in Dutch patients with colorectal cancer. Eur J Surg Oncol 2018; 45:160-166. [PMID: 30712552 DOI: 10.1016/j.ejso.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 09/23/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION This retrospective study aims to examine the association between body mass index (BMI) and serious postoperative complications, 30-day mortality and overall survival in colorectal cancer (CRC) patients. MATERIALS AND METHODS All CRC patients diagnosed between 2008 and 2013 in the south-eastern part of the Netherlands were included. Patients were categorized into four BMI groups: underweight (<18.5), normal weight (18.5 ≥ BMI<25), overweight (25 ≥ BMI<30), and obese (≥30). RESULTS A total of 7371 CRC patients were included (underweight 133 (1.8%); normal weight 2054 (41.4%); overweight 2955 (40.1%); obesity 1229 (16.7%)). Underweight patients were more likely to have postoperative complications (18.8% vs. 11.7%, adjusted OR 1.95, 95% CI 1.08-3.49) and had a worse 30-day mortality (9.8% vs. 3.3%, adjusted OR 4.37, 95% CI 2.03-9.42) compared to normal weight patients. After stratification for stage (stage I-III and stage IV), underweight was associated with a worse overall survival in both groups compared to normal weight (stage I-III: HR 2.06, 95%CI 1.51-2.80; stage IV: HR 1.65, 95% CI 1.11-2.45). Overweight was associated with an improved overall survival compared to normal weight in both stage groups. Only in stage IV patients obesity was associated with a significant better overall survival compared to stage IV normal weight patients. CONCLUSION Underweight CRC patients were more likely to have postoperative complications and a worse 30-day mortality compared to patients in other BMI categories. The underweight population also has a worse long-term survival while overweight CRC patients and obese stage IV CRC patients were associated with an improved survival compared to normal weight patients.
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Affiliation(s)
- J H C Arkenbosch
- Division of Surgical Oncology, Radboud University Medical Centre, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - F N van Erning
- Division of Research, Netherlands Comprehensive Cancer Organization (IKNL), Postbus 19079, 3501 DB, Utrecht, the Netherlands; Division of Public Health, Erasmus MC University Medical Centre, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - H J Rutten
- Division of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - D Zimmerman
- Division of Surgery, Elisabeth - TweeSteden Hospital, Doctor Deelenlaan 5, 5042 AD, Tilburg, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - S Beijer
- Division of Research, Netherlands Comprehensive Cancer Organization (IKNL), Postbus 19079, 3501 DB, Utrecht, the Netherlands.
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Bell S, Kong JC, Wale R, Staples M, Oliva K, Wilkins S, Mc Murrick P, Warrier SK. The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Dis 2018; 20:778-788. [PMID: 29577556 DOI: 10.1111/codi.14107] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Abstract
AIM Obesity is common in Western countries and its prevalence is increasing. Colorectal cancer is common, and surgery for colorectal cancer is technically more challenging in obese patients. Laparoscopic surgery for colon cancer has been shown to be oncologically equivalent, with improved short- term outcomes. Laparoscopic surgery for rectal cancer has proven technically challenging, and recent results have raised concerns about oncological equivalence. Our aim was to evaluate the effect of body mass index (BMI) on the clinical and oncological outcomes of surgery for colorectal cancer, including the rate at which laparoscopic surgery is attempted and the rate at which laparoscopic surgery is converted to open surgery. METHOD A retrospective analysis of prospectively collected data from two tertiary institutions was performed. Data were obtained from the Cabrini Monash University colorectal neoplasia database for patients having surgical resection for colon and rectal cancers between 1 January 2010 and 30 June 2015. Surgical and medical complications, tumour recurrence and overall survival and laparoscopic surgery and conversion rates were investigated. RESULTS This large case series of 1464 patients undergoing elective surgery for colorectal cancer has demonstrated that an elevated BMI is associated with a lower likelihood of attempting laparoscopic surgery and a higher conversion rate to open surgery when laparoscopy is attempted. Conversion was 1.9 times more likely in obese patients with colon cancer and 4.1 times more likely in obese patients with rectal cancer. The critical BMI for colon cancer patients was > 35 kg/m2 , and for rectal cancer patients > 30 kg/m2 . Obesity is also associated with increased rates of surgical complications, including anastomotic leakage and wound complications. Pathological parameters, tumour recurrence and survival were not affected by elevated BMI. CONCLUSION In the surgical management of colorectal cancer, obesity is associated with a lower likelihood of laparoscopic surgery being attempted, a higher likelihood of conversion to open surgery when laparoscopic surgery is attempted, and a higher rate of surgical complications.
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Affiliation(s)
- S Bell
- Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia.,Department of Surgery, Cabrini Hospital, Cabrini Monash University, Malvern, Australia
| | - J C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - R Wale
- Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia
| | - M Staples
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Australia
| | - K Oliva
- Department of Surgery, Cabrini Hospital, Cabrini Monash University, Malvern, Australia
| | - S Wilkins
- Department of Surgery, Cabrini Hospital, Cabrini Monash University, Malvern, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P Mc Murrick
- Department of Surgery, Cabrini Hospital, Cabrini Monash University, Malvern, Australia
| | - S K Warrier
- Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia
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Abstract
BACKGROUND Obese patients undergoing colorectal surgery are at increased risk for adverse outcomes. It remains unclear whether these risks can be further defined with more discriminatory stratifications of obesity. OBJECTIVE The purpose of this study was to understand the association between BMI and 30-day postoperative outcomes, including surgical site infection, among patients undergoing colorectal surgery. DESIGN This was a retrospective cohort study. SETTINGS The 2011-2013 American College of Surgeons National Surgical Quality Improvement Program database was used. PATIENTS Patients included those undergoing elective colorectal surgery in 2011-2013 who were assessed by the American College of Surgeons National Surgical Quality Improvement Program. MAIN OUTCOME MEASURES BMI was categorized into World Health Organization categories. Primary outcome was 30-day postoperative surgical site infection. Secondary outcomes included all American College of Surgeons National Surgical Quality Improvement Program-assessed 30-day postoperative complications. RESULTS Our cohort included 74,891 patients with 4.4% underweight (BMI <18.5), 29.0% normal weight (BMI 18.5-24.9), 33.0% overweight (BMI 25.0-29.9), 19.8% obesity class I (BMI 30.0-34.9), 8.4% obesity class II (BMI 35.0-39.9), and 5.5% obesity class III (BMI ≥40.0). Compared with normal-weight patients, obese patients experienced incremental odds of surgical site infection from class I to class III (I: OR = 1.5 (95% CI, 1.4-1.6); II: OR = 1.9 (95% CI, 1.7-2.0); III: OR = 2.1 (95% CI, 1.9-2.3)). Obesity class III patients were most likely to experience wound disruption, sepsis, respiratory or renal complication, and urinary tract infection. Mortality was highest among underweight patients (OR = 1.3 (95% CI, 1.0-1.8)) and lowest among overweight (OR = 0.8 (95% CI, 0.6-0.9)) and obesity class I patients (OR = 0.8 (95% CI, 0.6-1.0)). LIMITATIONS Retrospective analysis of American College of Surgeons National Surgical Quality Improvement Program hospitals may not represent patients outside of the American College of Surgeons National Surgical Quality Improvement Program and cannot assign causation or account for interventions to improve surgical outcomes. CONCLUSIONS Patients with increasing BMI showed an incremental and independent risk for adverse 30-day postoperative outcomes, especially surgical site infections. Strategies to address obesity preoperatively should be considered to improve surgical outcomes among this population. See Video Abstract at http://links.lww.com/DCR/A607.
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Kuritzkes BA, Pappou EP, Kiran RP, Baser O, Fan L, Guo X, Zhao B, Bentley-Hibbert S. Visceral fat area, not body mass index, predicts postoperative 30-day morbidity in patients undergoing colon resection for cancer. Int J Colorectal Dis 2018; 33:1019-1028. [PMID: 29658059 PMCID: PMC6198796 DOI: 10.1007/s00384-018-3038-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Colectomy for cancer in obese patients is technically challenging and may be associated with worse outcomes. Whether visceral obesity, as measured on computed tomography, is a better predictor of complication than body mass index (BMI) or determines long-term oncologic outcomes has not been well characterized. This study examines the association between derived anthropometrics and postoperative complication and long-term oncologic outcomes. METHODS Retrospective review of patients undergoing elective colectomy for cancer at a single tertiary-care center from 2010 to 2016. Adipose tissue distribution measurements, including visceral fat area (VFA), were determined from preoperative imaging. The primary outcome was 30-day postoperative complication; secondary outcomes included overall and disease-free survival. Multivariable logistic regression was performed to determine association between obesity metrics and outcome. RESULTS Two hundred and sixty-four patients underwent 266 primary resections of colon cancer. Twenty-eight patients (10.5%) developed major morbidity (Clavien-Dindo grade ≥ III). VFA but not BMI was significantly associated with morbidity in multivariate analysis (p = 0.004, odds ratio 1.99, 95% confidence interval 1.25-3.19). No other imaging-derived anthropometric was associated with increased morbidity. In receiver operating characteristic analysis, VFA was predictive of major morbidity (area under curve 0.660). A cutoff value of VFA ≥ 191 cm2 was associated with 50% sensitivity and 76% specificity for predicting major morbidity. Patients with VFA ≥ 191cm2 had 19.4% risk of morbidity, whereas those with < 191 cm2 had 7.2% risk (relative risk ratio 2.69, unadjusted p = 0.004). Neither VFA nor BMI was associated with overall or disease-free survival. CONCLUSION VFA but not BMI predicts morbidity following elective surgery for colon cancer.
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Affiliation(s)
- Benjamin A. Kuritzkes
- Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Emmanouil P. Pappou
- Division of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravi P. Kiran
- Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY 10032, USA,Center for Innovation and Outcomes Research, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Onur Baser
- Center for Innovation and Outcomes Research, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Liqiong Fan
- Center for Innovation and Outcomes Research, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Xiaotao Guo
- Computational Image Analysis Laboratory, Department of Radiology, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Binsheng Zhao
- Computational Image Analysis Laboratory, Department of Radiology, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Stuart Bentley-Hibbert
- Division of Abdominal Radiology, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
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Abstract
BACKGROUND The prevalence of obesity is as high as one-third of the adult population in the ultrasound. Obese patients operated for rectal cancer are less likely to undergo sphincter-preserving surgery, and have an increased morbidity and mortality. We aim to report the outcomes of transanal-endoscopic-microsurgery (TEM) in obese patients with benign and malignant neoplasms. MATERIALS AND METHODS An analysis was carried out of all patients undergoing TEM at a single institution between 2004 and 2015. Clinical, demographic, and pathologic data were analyzed in respect to BMI; a dichotomous variable was created categorizing the patients in this retrospective case series as either obese (BMI≥30) or nonobese (BMI<30). RESULTS Of the 158 patients who underwent TEM during the study period, 51 (32%) were obese and 107 (68%) were nonobese. No significant differences were found in terms of patients' demographics and tumor characteristics. There were no significant differences in operative time [105 min (range: 75-170) and 98 (range: 56-170), respectively, P=0.2], hospital length of stay [3 days (range: 2-6) and 4 (range: 2-12), respectively, P=0.48], or complication rates (20 and 23%, respectively, P=0.68). CONCLUSION TEM is a safe procedure for rectal neoplasms in the obese population. We found no difference in surgical time and completeness of specimen resection, and no increase in complications or length of stay in the hospital in obese versus nonobese patients. As for selected high risk patients, the TEM may be of benefit in obese patients with T1/T2N0M0 rectal cancer.
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Kumar L, Satheesan KN, Rajan S, Vasu BK, Paul J. Predictors and Outcomes of Postoperative Pulmonary Complications following Abdominal Surgery in a South Indian Population. Anesth Essays Res 2018; 12:199-205. [PMID: 29628582 PMCID: PMC5872864 DOI: 10.4103/aer.aer_69_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Postoperative pulmonary complications (PPC) following abdominal surgery are associated with increased morbidity and poorer outcomes. We prospectively examined risk factors associated with the development of PPC in patients undergoing abdominal surgery. Aims The primary outcome was to determine the association of predefined risk factors in the prediction of PPC after abdominal surgery. Secondary outcomes were evaluation of outcomes of PPC. Setting and Design This was a prospective study conducted in the gastrosurgical and urological units of a tertiary care referral hospital in patients undergoing abdominal surgery over a period of 6 months (November 2015-April 2016). Materials and Methods Relevant preoperative and intraoperative variables were recorded by the anesthesiologist in a pro forma provided. Postoperatively, data from the Intensive Care Unit (ICU) were collected from data sheets. PPC were defined according to preset criteria and outcomes of the patients including ICU stay, hospital stay, and mortality were noted. Statistical Analysis Chi-square test was used to find the association of risk factors of PPC. Mann-Whitney test was used for continuous variables and McNemar's test for postoperative respiratory variables. A final regression analysis was performed with factors with significant association (P < 0.1). Results One hundred and fifty patients were included, and 24 patients (16%) developed PPC as defined by our criteria. Emergency surgery (44.4% of PPC) and cardiac comorbidity (23.9% of PPC) were significant associations for pulmonary complications. The length of ICU and hospital stay (LOICU, LOHS) and mortality were higher in the group with pulmonary complications (P < 0.001). Conclusions Emergent surgery and cardiac comorbidities were independent predictors for the development of PPC. PPC are associated with increased LOHS, LOICU stay, and mortality.
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Affiliation(s)
- Lakshmi Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
| | - Keerthi N Satheesan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
| | - Bindu K Vasu
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
| | - Jerry Paul
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
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Pai A, Alsabhan F, Park JJ, Melich G, Sulo S, Marecik SJ. The Impact of Obesity on the Perioperative, Clinicopathologic, and Oncologic Outcomes of Robot Assisted Total Mesorectal Excision for Rectal Cancer. POLISH JOURNAL OF SURGERY 2017; 89:23-28. [PMID: 28905801 DOI: 10.5604/01.3001.0010.3906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To analyze the feasibility and outcomes of robotic rectal cancer surgery in obese patients. METHODS From 2005 to 2012, 101 consecutive rectal cancers operated robotically were enrolled in a prospective database. Patients were stratified into obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) groups. Operative, perioperative parameters, and pathologic outcomes were compared. Data were analyzed using SPSS 22.0, while statistical significance was defined as a p value ≤ .05. RESULTS There were 33 obese patients (mean BMI 33.8 kg/m2). Patients were comparable regarding gender, T stage, and type of operation. Operative time and blood loss were higher in the obese group; only operative time was statistically significant. The conversion rate, length of stay, and anastomotic leak rates were similar. Circumferential margin positivity and lymph node yield were comparable. Disease free and overall survivals at 3 years were 75.8% versus 80.9% and 84.8% versus 92.6%, respectively for obese and non-obese subgroups. CONCLUSIONS Robotic surgery for curative treatment of rectal cancer in the obese is safe and feasible. BMI does not influence conversion rates, length of stay, postoperative complications, and quality of the specimen or survival when the robotic platform is used.
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Affiliation(s)
- Ajit Pai
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, USA; University of Illinois at Chicago College of Medicine, Chicago IL, USA
| | - Fahad Alsabhan
- University of Illinois at Chicago College of Medicine, Chicago IL, USA
| | - John J Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, USA Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago IL, USA
| | - George Melich
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge IL, USA
| | - Slawomir J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, USA University of Illinois at Chicago College of Medicine, Chicago IL, USA
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Impact of Body Mass Index on Surgical and Oncological Outcomes in Laparoscopic Total Mesorectal Excision for Locally Advanced Rectal Cancer after Neoadjuvant 5-Fluorouracil-Based Chemoradiotherapy. Gastroenterol Res Pract 2017; 2017:1509140. [PMID: 29104590 PMCID: PMC5618776 DOI: 10.1155/2017/1509140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/23/2017] [Indexed: 01/04/2023] Open
Abstract
Aims To evaluate the impact of body mass index (BMI) on the surgical outcome of laparoscopic total mesorectal excision (laTME) for locally advanced rectal cancer (LARC, clinically staged as UICC stage II/III) after neoadjuvant chemoradiotherapy (nCRT). Methods 312 LARC patients undergoing laTME after nCRT were divided into nonobese (BMI < 25.0 kg/m2, n = 249) and obese (BMI ≥ 25.0 kg/m2, n = 63) groups. Preoperative radiotherapy was delivered in 45–50.4 Gy/25f, 5 days/week, and concurrent chemotherapy using FOLFOX or CapeOX. Technical feasibility, postoperative and oncological outcome were compared between groups. Results Obese patients had significantly longer operative time (P = 0.004). There was no significant difference regarding estimated blood loss, conversion, postoperative recovery, and morbidities. Multivariate analysis demonstrated that higher ASA score and abdominoperineal resection were risk factors for postoperative complications and diverting stoma was a protective factor. The length of resection margin, circumferential resection margin involvement, and number of lymph node retrieved were comparable. With a median follow-up time of 55 months (ranging 20–102 months), oncological outcome was comparable in terms of overall survival, local recurrence, and distant metastasis. Conclusions Obesity does not affect surgical or oncological outcome of laTME after nCRT. LaTME may be feasible and safe to obese LARC patients after nCRT in a specialized center.
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Newton PO, Bastrom TP, Yaszay B. Patient-Specific Risk Adjustment Improves Comparison of Infection Rates Following Posterior Fusion for Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2017; 99:1846-1850. [PMID: 29088039 DOI: 10.2106/jbjs.16.01442] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is increasing interest in surgeon "performance measures." Understanding patient factors that increase the risk of adverse events is important for the comparison of such metrics among surgeons and centers. The purpose of this study was to ascertain whether patient characteristics, beyond the control of the surgeon, were associated with increased risk of postoperative infection following posterior spinal fusion for the correction of adolescent idiopathic scoliosis (AIS) and to establish a "risk-adjusted" method of reporting postoperative infection rates. METHODS We reviewed the data of patients from 14 participating scoliosis treatment centers who experienced an infection within 90 days following posterior spinal fusion for the treatment of AIS. Patients with a deep infection (irrigation and debridement performed) were compared with those without an infection with regard to age, sex, body mass index (BMI) percentile for age, Lenke classification of curve type, primary curve magnitude, and estimated 3-dimensional sagittal kyphosis (T5-T12). A regression model was created to identify variables that were associated with infection, and the performance of the risk model was evaluated. The actual infection rate by site was divided by the predicted infection rate for that site and multiplied by the overall rate to create a risk-adjusted rate. RESULTS Of 2,122 patients analyzed, 21 (1.0%) had an infection within 90 days following surgery. Obesity was the only significant risk factor (odds ratio [OR], 7.6; p ≤ 0.001), with the resultant model demonstrating good discrimination and calibration. For the 8 sites that enrolled ≥100 patients, the predicted infection rates based on the proportion of obese patients ranged from 0.8% to 1.2%. The range of the risk-adjusted infection rates varied more substantially, from 0.2% to 2.0%. CONCLUSIONS For the posterior approach to surgical correction of AIS, the only identified patient risk factor for postoperative infection was a BMI percentile for age of ≥95%. To assess infection rates, we suggest adjusting for the proportion of obese patients in the cohort. A risk-adjusted infection rate for posterior spinal fusion with instrumentation for AIS allows for more accurate assessment of performance and comparison among centers. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter O Newton
- 1Orthopedics and Scoliosis Division, Rady Children's Hospital, San Diego, California 2Department of Orthopaedic Surgery, University of California, San Diego, California
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Association Between Obesity and Wound Infection Following Colorectal Surgery: Systematic Review and Meta-Analysis. J Gastrointest Surg 2017; 21:1700-1712. [PMID: 28785932 DOI: 10.1007/s11605-017-3494-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/30/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this meta-analysis is to comprehensively review and quantify the excess risk of surgical site infections (SSI) in obese patients following colorectal surgery. METHODS A systematic electronic search of the MEDLINE and EMBASE databases identified studies that investigated the association of obesity, defined by body mass index (BMI) with SSI among colorectal surgery patients. RESULTS Twelve studies were included in the final analysis. Patients with BMI ≥30 kg/m2 were at 1.5 times (pooled OR 1.51, 95% CI: 1.39, 1.63, p < 0.001) higher odds of developing SSI after colorectal surgery when compared to BMI <30 kg/m2. Subgroup analysis of the eight studies that investigated only elective procedures showed that the odds of developing SSI when BMI ≥30 kg/m2 is 1.6 times that of those with BMI <30 kg/m2 (pooled OR 1.60; 95% CI 1.34, 1.86; p < 0.001). The odds of having SSI when BMI is 25-29.9 kg/m2 are 1.2 times than those with BMI <25 kg/m2 (pooled OR 1.17; 95% CI 1.07, 1.28; p < 0.001). CONCLUSION Overweight and obese patients carry at least 20% and 50% higher odds of developing SSI after colorectal surgery compared to normal weight patients, respectively.
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Laparoscopic colectomy in the obese, morbidly obese, and super morbidly obese: when does weight matter? Int J Colorectal Dis 2017; 32:1447-1451. [PMID: 28710609 DOI: 10.1007/s00384-017-2865-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have demonstrated that obese patients (BMI >30) undergoing laparoscopic colectomy have longer operative times and increased complications when compared to non-obese cohorts. However, there is little data that specifically evaluates the outcomes of obese patients based on the degree of their obesity. The aim of this study was to evaluate the impact of increasing severity of obesity on patients undergoing laparoscopic colectomy. METHODS A retrospective review was performed of all patients undergoing laparoscopic colectomy between 1996 and 2013. Patients were classified according to their BMI as obese (BMI 30.0-39.9), morbidly obese (BMI 40.0-49.9), and super obese (BMI >50). Main outcome measures included conversion rate, operative time, estimated blood loss, post-operative complications, and length of stay. RESULTS There were 923 patients who met inclusion criteria. Overall, 604 (65.4%), 257 (27.9%), and 62 (6.7%) were classified as obese (O), morbidly obese (MO), and super obese (SO), respectively. Clinicopathologic characteristics were similar among the three groups. The SO group had significantly higher conversion rates (17.7 vs. 7 vs. 4.8%; P = 0.031), longer average hospital stays (7.1 days vs. 4.9 vs. 3.4; P = 0.001), higher morbidity (40.3 vs. 16.3 vs. 12.4%; P = 0.001), and longer operative times (206 min vs. 184 vs. 163; P = 0.04) compared to the MO and O groups, respectively. The anastomotic leak rate in the SO (4.8%; P = 0.027) and MO males (4.1%; P = 0.033) was significantly higher than MO females (2.2%) and all obese patients (1.8%). CONCLUSION Increasing severity of obesity is associated with worse perioperative outcomes following laparoscopic colectomy.
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Schootman M, Hendren S, Loux T, Ratnapradipa K, Eberth J, Davidson N. Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy. J Gastrointest Surg 2017; 21:1296-1303. [PMID: 28567574 PMCID: PMC5576564 DOI: 10.1007/s11605-017-3460-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/17/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients. METHODS We used the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex. RESULTS In all, 17.1% of the 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as nonobese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 min longer. We found no statistically significant differences (p > 0.05) by obesity status and gender. CONCLUSIONS Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.
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Affiliation(s)
- M. Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO
| | - S. Hendren
- University of Michigan, Department of Surgery, Ann Arbor, MI
| | - T. Loux
- Saint Louis University, College for Public Health and Social Justice, Department of Biostatistics, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - K. Ratnapradipa
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - J.M. Eberth
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
| | - N.O. Davidson
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO,Washington University School of Medicine, Department of Medicine, Division of Gastroenterology, Saint Louis, MO
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