Kuritzkes Benjamin A, Pappou Emmanouil P, Kiran Ravi P, Baser Onur, Fan Liqiong, Guo Xiaotao, Zhao Binsheng, Bentley-Hibbert Stuart
Division of Colorectal Surgery, New York Presbyterian/Columbia University Medical Center, Herbert Irving Pavilion, 8th Fl., 161 Fort Washington Avenue, New York, NY, 10032, USA.
Division of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Int J Colorectal Dis. 2018 Aug;33(8):1019-1028. doi: 10.1007/s00384-018-3038-2. Epub 2018 Apr 15.
Colectomy for cancer in obese patients is technically challenging and may be associated with worse outcomes. Whether visceral obesity, as measured on computed tomography, is a better predictor of complication than body mass index (BMI) or determines long-term oncologic outcomes has not been well characterized. This study examines the association between derived anthropometrics and postoperative complication and long-term oncologic outcomes.
Retrospective review of patients undergoing elective colectomy for cancer at a single tertiary-care center from 2010 to 2016. Adipose tissue distribution measurements, including visceral fat area (VFA), were determined from preoperative imaging. The primary outcome was 30-day postoperative complication; secondary outcomes included overall and disease-free survival. Multivariable logistic regression was performed to determine association between obesity metrics and outcome.
Two hundred and sixty-four patients underwent 266 primary resections of colon cancer. Twenty-eight patients (10.5%) developed major morbidity (Clavien-Dindo grade ≥ III). VFA but not BMI was significantly associated with morbidity in multivariate analysis (p = 0.004, odds ratio 1.99, 95% confidence interval 1.25-3.19). No other imaging-derived anthropometric was associated with increased morbidity. In receiver operating characteristic analysis, VFA was predictive of major morbidity (area under curve 0.660). A cutoff value of VFA ≥ 191 cm was associated with 50% sensitivity and 76% specificity for predicting major morbidity. Patients with VFA ≥ 191cm had 19.4% risk of morbidity, whereas those with < 191 cm had 7.2% risk (relative risk ratio 2.69, unadjusted p = 0.004). Neither VFA nor BMI was associated with overall or disease-free survival.
VFA but not BMI predicts morbidity following elective surgery for colon cancer.
对肥胖患者进行癌症结肠切除术在技术上具有挑战性，且可能与更差的预后相关。通过计算机断层扫描测量的内脏肥胖是否比体重指数（BMI）更能预测并发症，或者是否能决定长期肿瘤学预后，目前尚未得到充分阐明。本研究探讨了衍生人体测量学与术后并发症及长期肿瘤学预后之间的关联。
回顾性分析2010年至2016年在一家三级医疗中心接受择期癌症结肠切除术的患者。根据术前影像学确定脂肪组织分布测量值，包括内脏脂肪面积（VFA）。主要结局是术后30天并发症；次要结局包括总生存期和无病生存期。进行多变量逻辑回归以确定肥胖指标与结局之间的关联。
264例患者接受了266例结肠癌初次切除术。28例患者（10.5%）发生了严重并发症（Clavien-Dindo分级≥III级）。在多变量分析中，VFA而非BMI与并发症显著相关（p = 0.004，比值比1.99，95%置信区间1.25 - 3.19）。没有其他影像学衍生的人体测量学指标与并发症增加相关。在受试者工作特征分析中，VFA可预测严重并发症（曲线下面积0.660）。VFA≥191 cm的截断值对于预测严重并发症具有50%的敏感性和76%的特异性。VFA≥191 cm的患者发生并发症的风险为19.4%，而VFA<191 cm的患者为7.2%（相对风险比2.69，未校正p = 0.004）。VFA和BMI均与总生存期或无病生存期无关。
VFA而非BMI可预测结肠癌择期手术后的并发症。
