Influence of overweight and obesity on complications in colorectal surgery
Authors:
Z. Adamová; T. Bár
Authors‘ workplace:
Chirurgické oddělení, Vsetínská nemocnice, a. s.
Published in:
Rozhl. Chir., 2018, roč. 97, č. 10, s. 464-468.
Category:
Original articles
Overview
Introduction:
Overweight and obesity are recognized as risk factors for many health-related disorders like diabetes, cardiovascular disease and malignancy. On the other hand, according to recent studies, they may be a favorable prognostic factor in patients treated for various chronic diseases. Patients with increased body mass index (BMI) have a lower mortality rate, which is known as the “obesity paradox”. Overweight and obese patients, as reported by several papers, also have better outcomes after surgery. The aim of our study was to evaluate this somewhat surprising phenomenon on our group of patients.
Methods:
The medical records of patients diagnosed with colorectal cancer who were treated with resection and primary anastomosis from 1 January 2010 to 31 December 2017 were retrospectively analyzed. Patients after multivisceral resections or with lacking data were excluded. We did not evaluate two underweight patients. The BMI classification of the World Health Organization was used. Postoperative complications, anastomotic leak, mortality and length of stay in hospital were investigated.
Results:
225 patients were included. 56 (24.9%) patients had normal weight – group A, 98 (43.6%) patients were overweight – group B, 58 (25.7%) patients had class I obesity – group C, 9 (4%) patients had class II obesity and 4 (1.8%) patients class III obesity – together they form group D. The groups did not significantly differ in age, sex, comorbidities, cancer stage and locality. Complications occurred as follows: A–29%; B–25%; C–36%; D–55%. Anastomotic leak: A–9%; B–4%; C–9%; D–15%. Mortality: A–5%; B–2%; C–2%, D–0%. Average length of stay: A–11.7 days; B –11.3 days; C–12.6 days; D–47 days. We did not observe any statistically significant difference.
Conclusions:
Overweight surgical colorectal cancer patients had the lowest incidence of complications, anastomotic leak and the shortest length of stay. Obesity was associated with more complications but reduced inhospital mortality. Probably due to the relatively small number of patients, we did not prove any statistically significant difference.
Key words:
obesity paradox – BMI – colorectal cancer – resection – omplications
Sources
- Share of overweight population by sex and age. 2017. Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php?title=File:Share_of_overweight_population_by_sex_and_age,_2014.png&oldid=331854.
- Adult obesity prevalence maps. 2017. Available from: https://www.cdc.gov/obesity/data/prevalence-maps.html.
- Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008;156:13–22.
- Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 2006;368:666–78.
- Angelo F, Luca I, Maurizio R, et al. The obesity paradox and osteoporosis. Eat Weight Disord 2018. Available from: 10.1007/s40519-018-0505-2. [Epub ahead of print]
- Yajima T, Yajima K, Takahashi H, et al. The impact of abdominal fat Levels on all-cause mortality risk in patients undergoing hemodialysis. Nutrients 2018;10:480.
- Kalantar-Zadeh K, Kopple JD. Obesity paradox in patients on maintenance dialysis. Contrib Nephrol 2006;151:57–69.
- Oreopoulos A, Padwal R, Norris CM, et al. Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity (Silver Spring) 2008;16:442–50.
- Davenport DL, Xenos ES, Hosokawa P, et al. The influence of body mass index obesity status on vascular surgery 30-day morbidity and mortality. J Vasc Surg 2009;49:140–7.
- Jackson RS, Black JH 3rd, Lum YW, et al. Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy. J Vasc Surg 2012;55:1306−12.
- Govaert JA, Lijftogt N, van Dijk WA, et al. Colorectal cancer surgery for obese patients: Financial and clinical outcomes of a Dutch population-based registry. J Surg Oncol 2016;113:489−95.
- Yasunaga H, Horiguchi H, Matsuda S, et al. Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg 2013;100:1335–43.
- Benjamin ER, Dilektasli E, Haltmeier T, et al. The effects of body mass index on complications and mortality after emergency abdominal operations: The obesity paradox. Am J Surg 2017;214:899−903.
- Mullen JT, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 2009;250:166−7.
- Mariscalco G, Wozniak MJ, Dawson AG, et al. Body mass index and mortality among adults undergoing cardiac surgery: A nationwide study with a systematic review and meta-analysis. Circulation. 2017;135:850−63.
- Valentijn TM, Galal W, Hoeks SE, et al. Impact of obesity on postoperative and long-term outcomes in a general surgery population: A retrospective cohort study. World J Surg 2013;37:2561–8.
- Rios-Diaz AJ, Lin E, Williams K, et al. The obesity paradox in patients with severe soft tissue infections. Am J Surg 2017;214:385−9.
- Utzolino S, Ditzel CHM, Baier PK, et al. The obesity paradox in surgical intensive care patients with peritonitis. Journal of Critical Care 2014;887:e1–887,e5.
- Tokunaga M, Hiki N, Fukunaga T, et al. Better 5 year survive rate following curative gastrectomy in overweight patients. Ann Surg Oncol 2009;16:3245−51.
- Galal W, van Gestel YRBM, Hoeks SE, et al. The obesity paradox in patients with peripheral arterial disease. Chest 2008;134:925−3.
- Valentijn TM, Galal W, Tjeertes EK, et al. The obesity paradox in the surgical population. Surgeon 2013;11:16−76.
- Arabi YM, Dara SI, Tamim HM, et al. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care 2013;17:R72.
- Mohamed-Ali V, Goodrick S, Bulmer K, et al. Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol 1999;277:E971−5.
- Spartalis M, Tzatzaki E, Moris D, et al. Morbidity, mortality, and obesity paradox. Ann Transl Med 2017;5:440.
- Hainer V, Hainerova IA. Obesity paradox does exist. Diabetes Care 2013;36(Suppl 2):S276–S281.
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Perspectives in Surgery
2018 Issue 10
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