Ann Surg Treat Res.  2019 Feb;96(2):86-94. 10.4174/astr.2019.96.2.86.

Oncologic evaluation of obesity as a factor in patients with rectal cancer undergoing laparoscopic surgery: a propensity-matched analysis using body mass index

• Son IT
• Kim DW
• Choe EK
• Kim YH
• Lee KH
• Ahn S
• Kang SI
• Kim MJ
• Oh HK
• Kim JS
• Kang SB

• KMID: 2433945
• DOI: http://doi.org/10.4174/astr.2019.96.2.86

Abstract

PURPOSE
This study evaluated the oncologic impact of obesity, as determined by body mass index (BMI), in patients who underwent laparoscopic surgery for rectal cancer.
METHODS
The records of 483 patients with stage I-III rectal cancer who underwent laparoscopic surgery between June 2003 and December 2011 were reviewed. A matching model based on BMI was constructed to balance obese and nonobese patients. Cox hazard regression models for overall survival (OS) and disease-free survival (DFS) were used for multivariate analyses. Additional analysis using visceral fat area (VFA) measurement was performed for matched patients. The threshold for obesity was BMI ≥ 25 kg/m2 or VFA ≥ 130 cm2.
RESULTS
The score matching model yielded 119 patients with a BMI ≥ 25 kg/m2 (the obese group) and 119 patients with a BMI < 25 kg/m2 (the nonobese group). Surgical outcomes including operation time, estimated blood loss, nil per os periods, and length of hospital stay did not differ between the obese and the nonobese group. The retrieved lymph node numbers and pathologic CRM positive rate were also similar in between the 2 groups. After a median follow-up of 48 months (range, 3-126 months), OS and DFS rates were similar between the 2 groups. A tumor location-adjusted model for overall surgical complications showed that a BMI ≥ 25 kg/m2 were not risk factors. Multivariable analyses for OS and DFS showed no significant association with a BMI ≥ 25 kg/m2.
CONCLUSION
Obesity was not associated with long-term oncologic outcomes in patients undergoing laparoscopic surgery for rectal cancer in the Asian population.

Keyword

Body mass index; Rectal neoplasms; Laparoscopy

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index*
Disease-Free Survival
Follow-Up Studies
Humans
Intra-Abdominal Fat
Laparoscopy*
Length of Stay
Lymph Nodes
Multivariate Analysis
Obesity*
Rectal Neoplasms*
Risk Factors

Figure

• 

  Fig. 1 Flow chart for matching and validation of obese and nonobese patients. a)Matched covariates including age, sex, tumor height, American Society of Anesthesiologists physical status classification, preoperative radiotherapy, chemotherapy, differentiation type and T–N stage. BMI, body mass index.

• 

  Fig. 2 The relationship of body mass index (BMI) with visceral fat area (VFA). Coefficient of correlation, R2 = 0.436, P < 0.001.

• 

  Fig. 3 (A) Scatter plots showing the relationships of body mass index with operation time according to tumor location. (B) Operation time was compared between obese and nonobese patients, based on a body mass index (BMI) cutoff of 25 kg/m2. AV, anal verge.

• 

  Fig. 4 Kaplan-Meier analyses of overall survival (A) and disease-free survival (B) in the 119 matched pairs of obese and nonobese patients, based on the World Health Organization cutoff of body mass index (BMI) of 25 kg/m2. Patients were matched 1:1 based on age, sex, tumor height, American Society of Anesthesiologists physical status classification, preoperative treatment, differentiation type, and T–N stage.

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