Kwak Han Deok, Ju Jae Kyun, Kang Dong Woo, Baek Se-Jin, Kwak Jung Myun, Kim Jin, Kim Seon-Hahn
Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.
Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
J Minim Access Surg. 2018 Apr-Jun;14(2):134-139. doi: 10.4103/jmas.JMAS_68_17.
Body mass index (BMI) may not be appropriate for different populations. Therefore, the World Health Organization (WHO) suggested 25 kg/m as a measure of obesity for Asian populations. The purpose of this report was to compare the oncologic outcomes of laparoscopic colorectal resection with BMI classified from the WHO Asia-Pacific perspective.
All patients underwent laparoscopic colorectal resection from September 2006 to March 2015 at a tertiary referral hospital. A total of 2408 patients were included and classified into four groups: underweight (n = 112, BMI <18.5 kg/m), normal (n = 886, 18.5-22.9 kg/m), pre-obese (n = 655, 23-24.9 kg/m) and obese (n = 755, >25 kg/m). Perioperative parameters and oncologic outcomes were analysed amongst groups.
Conversion rate was the highest in the underweight group (2.7%, P < 0.001), whereas the obese group had the fewest harvested lymph nodes (21.7, P < 0.001). Comparing oncologic outcomes except Stage IV, the underweight group was lowest for overall (P = 0.007) and cancer-specific survival (P = 0.002). The underweight group had the lowest proportion of national health insurance but the highest rate of medical care (P = 0.012).
The obese group had the fewest harvested lymph nodes, whereas the underweight group had the highest estimated blood loss, conversion rate to open approaches and the poorest overall and cancer-specific survivals.
体重指数（BMI）可能不适用于不同人群。因此，世界卫生组织（WHO）建议将25kg/m²作为亚洲人群肥胖的衡量标准。本报告的目的是从WHO亚太地区的角度比较不同BMI分类的腹腔镜结直肠癌切除术的肿瘤学结局。
2006年9月至2015年3月期间，所有患者均在一家三级转诊医院接受了腹腔镜结直肠癌切除术。共纳入2408例患者，分为四组：体重过低（n = 112，BMI<18.5kg/m²）、正常（n = 886，18.5 - 22.9kg/m²）、肥胖前期（n = 655，23 - 24.9kg/m²）和肥胖（n = 755，>25kg/m²）。分析各组围手术期参数和肿瘤学结局。
体重过低组的中转开腹率最高（2.7%，P<0.001），而肥胖组收获的淋巴结最少（21.7枚，P<0.001）。比较除IV期外的肿瘤学结局，体重过低组的总生存率（P = 0.007）和癌症特异性生存率最低（P = 0.002）。体重过低组参加国民健康保险的比例最低，但医疗费用率最高（P = 0.012）。
肥胖组收获的淋巴结最少，而体重过低组估计失血量最高、中转开腹率最高，且总生存率和癌症特异性生存率最差。
