Cakir Hamit, Heus Colin, Verduin Wouter M, Lak Arjen, Doodeman Hieronymus J, Bemelman Willem A, Houdijk Alexander P
Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
Trial Center Holland Health, Alkmaar, The Netherlands.
Surgery. 2015 May;157(5):909-15. doi: 10.1016/j.surg.2014.12.012. Epub 2015 Feb 21.
The aim of our study was to assess the influence of visceral obesity (VO), as measured by preoperative abdominal CT scan, in relation to body mass index (BMI) on the incidence of postoperative complications and duration of hospital stay after colon cancer surgery.
Patients who underwent elective resection for colon cancer between January 1, 2006, and December 31, 2013, and had a preoperative CT scan were entered in the study. Visceral fat area (VFA) was determined by using the preoperative CT scan at the L3-L4 level. The effect of VO, defined as a VFA of >100 cm², on postoperative complications and duration of hospital stay was analyzed.
Of 564 included patients, 65% had VO. VO was associated with more anastomotic leakage (P = .04), pneumonia (P = .02), wound infection (P = .03), reoperations (P = .04), and longer duration of hospital stay (P = .05). Of patients with a BMI < 25 kg/m², 44% had VO. In this group, VO was associated significantly with postoperative complications, cardiac (P < .01) and pulmonary (P = .01) comorbidity, hypertension (P < .01), and diabetes (P < .01). In the overweight (BMI 25-30 kg/m²) and obese (BMI > 30 kg/m²) groups, the rate of VO was much higher (81% and 90%, respectively), but was not associated significantly with complications or comorbidity, except for cardiac comorbidity (P < .02) in the BMI = 25-30 kg/m² group. After multivariable analysis, VO was shown to be an independent predictor of anastomotic leakage and wound infection.
The association of VO with worse outcome after colon cancer surgery is most pronounced in patients with a BMI < 25 kg/m².
我们研究的目的是评估术前腹部CT扫描测量的内脏肥胖（VO）与体重指数（BMI）对结肠癌手术后并发症发生率和住院时间的影响。
纳入2006年1月1日至2013年12月31日期间接受择期结肠癌切除术且术前行CT扫描的患者。通过术前L3-L4水平的CT扫描确定内脏脂肪面积（VFA）。分析定义为VFA>100 cm²的VO对术后并发症和住院时间的影响。
在纳入的564例患者中，65%有VO。VO与更多的吻合口漏（P = 0.04）、肺炎（P = 0.02）、伤口感染（P = 0.03）、再次手术（P = 0.04）以及更长的住院时间（P = 0.05）相关。在BMI<25 kg/m²的患者中，44%有VO。在该组中，VO与术后并发症、心脏（P<0.01）和肺部（P = 0.01）合并症、高血压（P<0.01）和糖尿病（P<0.01）显著相关。在超重（BMI 25-30 kg/m²）和肥胖（BMI>30 kg/m²）组中，VO发生率更高（分别为81%和90%），但除BMI = 25-30 kg/m²组的心脏合并症（P<0.02）外，与并发症或合并症无显著相关性。多变量分析后，VO被证明是吻合口漏和伤口感染的独立预测因素。
VO与结肠癌手术后较差结局的关联在BMI<25 kg/m²的患者中最为明显。
