Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma

• Published in: Journal of surgical oncology 2012-03, Vol.105 (4), p.365-370
• Main Authors: Ballian, Nikiforos, Lubner, Meghan G., Munoz, Alejandro, Harms, Bruce A., Heise, Charles P., Foley, Eugene F., Kennedy, Gregory D.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Body Mass Index; Cohort Studies; Digestive System Surgical Procedures; Female; Humans; Intra-Abdominal Fat - pathology; Male; Middle Aged; obesity; Obesity, Abdominal - complications; Prognosis; rectal cancer; Rectal Neoplasms - complications; Rectal Neoplasms - mortality; Rectal Neoplasms - surgery; Subcutaneous Fat - pathology; Survival Rate; Tomography, X-Ray Computed; total mesorectal excision; visceral fat area
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.22031

Background and Objectives General obesity, measured by the body mass index (BMI), increases the technical difficulty of total mesorectal excision (TME) but does not affect oncologic outcomes. The purpose of this study is to compare visceral and general obesity as predictors of outcomes of TME for rectal adenocarcinoma. Methods Adult patients undergoing TME for rectal adenocarcinoma were retrospectively identified. Preoperative computed tomography scans were used to measure abdominal circumference (AC), visceral (VFA), and subcutaneous fat area (SFA). BMI, AC, VFA, SFA, total fat area (TFA, sum of VFA and SFA), and VFA/SFA ratio were examined for association with operative, postoperative, oncologic, and survival outcomes in a univariate analysis model. Results Between 1999 and 2009, 113 patients met inclusion criteria. Increasing VFA and VFA/SFA ratio were associated with reduced lymph node retrieval (P = 0.03 and P = 0.009, respectively). The association between increasing VFA/SFA ratio with delayed resumption of oral intake (P = 0.05) and prolonged overall survival (P = 0.003) were also significant. Increasing BMI was associated with improved overall (P = 0.02) but not disease‐free survival (P = 0.14). Conclusion Visceral obesity, measured by VFA/SFA ratio, is a better predictor of postoperative, oncologic, and survival outcomes after TME for rectal adenocarcinoma than general obesity measured by the BMI. J. Surg. Oncol. 2012;105:365–370. © 2011 Wiley Periodicals, Inc.