Akiyoshi Takashi, Ueno Masashi, Fukunaga Yosuke, Nagayama Satoshi, Fujimoto Yoshiya, Konishi Tsuyoshi, Kuroyanagi Hiroya, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
Surg Laparosc Endosc Percutan Tech. 2011 Dec;21(6):409-14. doi: 10.1097/SLE.0b013e31822e5fdc.
The impact of body mass index (BMI) on laparoscopic surgery for colorectal cancer in Asian countries is unclear, partly because obesity is less common in Asia than in western countries. The purpose of this study was to evaluate the association between BMI and short-term outcomes after laparoscopic resection for colorectal cancer in Japanese patients.
A cohort of 1194 patients who underwent laparoscopic resection for colorectal cancer at Cancer Institute Hospital between July 2005 and February 2010 were enrolled in this prospective study. Outcomes were analyzed according to BMI category: nonobese (BMI<25), obese I (25 ≤ BMI < 30), and obese II (BMI ≥ 30).
A total of 926 patients (78%) were classified as nonobese, 243 (20%) were obese I, and 25 (2%) were obese II. Mean operating time (214 min vs. 244 min vs. 293 min) and mean estimated blood loss (23 mL vs. 42 mL vs. 88 mL) increased significantly with increasing BMI (P<0.0001, respectively). The rate of postoperative complications was significantly higher in obese II patients than in nonobese and obese I patients (24% vs. 9.2% vs. 9.1%, P=0.0428). Multivariate analysis showed that a BMI in the obese II range was an independent predictive factor for developing anastomotic leakage (odds ratio: 10.27, 95% confidence interval, 1.98-53.44).
Laparoscopic surgery for colorectal cancer is technically more demanding in Japanese obese II patients than in nonobese or obese I patients. Special care is required because of the increased risk of developing postoperative complications.
在亚洲国家，体重指数（BMI）对结直肠癌腹腔镜手术的影响尚不清楚，部分原因是亚洲肥胖的发生率低于西方国家。本研究旨在评估日本患者BMI与结直肠癌腹腔镜切除术后短期结局之间的关联。
本前瞻性研究纳入了2005年7月至2010年2月在癌症研究所医院接受结直肠癌腹腔镜切除术的1194例患者。根据BMI类别分析结局：非肥胖（BMI<25）、肥胖I级（25≤BMI<30）和肥胖II级（BMI≥30）。
共有926例患者（78%）被分类为非肥胖，243例（20%）为肥胖I级，25例（2%）为肥胖II级。随着BMI增加，平均手术时间（214分钟对244分钟对293分钟）和平均估计失血量（23毫升对42毫升对88毫升）显著增加（P均<0.0001）。肥胖II级患者术后并发症发生率显著高于非肥胖和肥胖I级患者（24%对9.2%对9.1%，P=0.0428）。多因素分析显示，肥胖II级范围内的BMI是发生吻合口漏的独立预测因素（比值比：10.27，95%置信区间，1.98-53.44）。
对于日本肥胖II级患者，结直肠癌腹腔镜手术在技术上比非肥胖或肥胖I级患者要求更高。由于术后并发症发生风险增加，需要特别护理。
