Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2013 Jun;56(6):689-97. doi: 10.1097/DCR.0b013e3182880ffa.
The impact of obesity per se on the surgical strategy, ie, sphincter sacrifice (abdominoperineal resection) vs sphincter-preserving resection, outcomes, and long-term maintenance of intestinal continuity has been poorly studied in patients with mid and low rectal cancer.
The aim of this study is to compare the outcomes and long-term maintenance of intestinal continuity for obese and nonobese patients treated surgically for mid and low rectal cancers.
This is a retrospective cohort study from a prospectively collected database.
The investigation took place in a high-volume specialized colorectal surgery department.
All patients who underwent curative surgery for mid or low rectal adenocarcinoma at a single institution from 1976 to 2011 were identified.
Obese (BMI ≥ 30 kg/m) and nonobese patients were matched 1:2 for age, sex, ASA class, location, and stage of tumor. Demographics, use of neoadjuvant chemoradiotherapy, operative and perioperative outcomes, pathology, long-term outcomes including oncologic outcomes, and whether restoration of intestinal continuity was obtained were compared.
One hundred fifty-seven obese patients and 314 nonobese patients were included in the study. The groups were similar for matched characteristics. The use of neoadjuvant chemoradiotherapy (p = 0.048) and anastomotic leak (p = 0.0003) rates were higher in obese patients. A similar proportion of nonobese and obese patients underwent sphincter-preserving resection (p > 0.99), and postoperative hospital stay (p = 0.23), 30-day postoperative reoperation (p = 0.83), mortality (p > 0.99), and readmissions (p = 0. 13) were similar. The obese and nonobese groups had similar overall (p = 0.61) and disease-free survival (p = 0.74) at a mean follow-up of 5 years for both groups.
This study was limited by its retrospective and nonrandomized nature.
At a high-volume specialized colorectal unit, proctectomy can be performed in obese patients with similar long-term oncologic outcomes and ability to restore intestinal continuity in comparison with nonobese patients. Proctectomy in obese patients, however, is associated with an increased risk of anastomotic leak in comparison with nonobese patients.
肥胖本身对手术策略的影响，即肛门直肠切除术（腹会阴切除术）与保留括约肌切除术，以及中低位直肠癌患者的治疗结果和长期维持肠道连续性的影响，在研究中研究得并不充分。
本研究旨在比较肥胖和非肥胖患者接受中低位直肠癌手术治疗的结果和长期维持肠道连续性。
这是一项从前瞻性收集的数据库中进行的回顾性队列研究。
该研究在一家高容量的专业结直肠外科部门进行。
从 1976 年至 2011 年，在一家机构接受中低位直肠腺癌根治性手术的所有患者均被确定。
肥胖（BMI≥30kg/m2）和非肥胖患者按照年龄、性别、ASA 分级、肿瘤部位和分期进行 1:2 匹配。比较两组患者的人口统计学资料、新辅助放化疗的使用、手术和围手术期结果、病理学结果、长期结果（包括肿瘤学结果）以及是否恢复肠道连续性。
共纳入 157 例肥胖患者和 314 例非肥胖患者。两组在匹配特征上相似。肥胖患者新辅助放化疗的使用率（p=0.048）和吻合口漏的发生率（p=0.0003）更高。非肥胖患者和肥胖患者行保留括约肌切除术的比例相似（p＞0.99），术后住院时间（p=0.23）、30 天术后再次手术（p=0.83）、死亡率（p＞0.99）和再入院率（p=0.13）相似。在平均随访 5 年的两组中，肥胖组和非肥胖组的总体生存率（p=0.61）和无病生存率（p=0.74）相似。
本研究受限于其回顾性和非随机性。
在一家高容量的专业结直肠外科单位，与非肥胖患者相比，肥胖患者的直肠切除术可以获得相似的长期肿瘤学结果，并能够恢复肠道连续性。然而，与非肥胖患者相比，肥胖患者的吻合口漏风险增加。
