Department of Surgery, Leiden University Medical Center, Leiden, Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.
Eur J Surg Oncol. 2018 Dec;44(12):1849-1857. doi: 10.1016/j.ejso.2018.05.027. Epub 2018 Jun 6.
Obesity is an increasing problem worldwide that can influence perioperative and postoperative outcomes. However, the relationship between obesity and treatment-related perioperative and short-term postoperative morbidity after colorectal resections is still subject to debate.
Patients were selected from the DCRA, a population-based audit including 83 hospitals performing colorectal cancer (CRC) surgery. Data regarding primary resections between 2009 and 2016 were eligible for analyses. Patients were subdivided into six categories: underweight, normal weight, overweight and obesity class I, II and III.
Of 71,084 patients, 17.7% with colon and 16.4% with rectal cancer were categorized as obese. Significant differences were found for the 30-day overall postoperative complication rate (p < 0.001), prolonged hospitalization (p < 0.001) and readmission rate (colon cancer p < 0.005; rectal cancer p < 0.002) in obese CRC patients. Multivariate analysis identified BMI ≥30 kg/m as independent predictor of a complicated postoperative course in CRC patients. Furthermore, obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate. No significant differences in performance were observed in postoperative outcomes of morbidly obese CRC patients between hospitals performing bariatric surgery and hospitals that did not.
The real-life data analysed in this study reflect daily practice in the Netherlands and identify obesity as a significant risk factor in CRC patients. Obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate in obese CRC patients. No differences were observed between hospitals performing bariatric surgery and hospitals that did not.
肥胖是一个全球性的日益严重的问题，会影响围手术期和术后结果。然而，肥胖与结直肠切除术后相关的围手术期和短期术后发病率之间的关系仍存在争议。
该研究从 DCRA 中选择患者，该研究是一项基于人群的审计，包括 83 家进行结直肠癌（CRC）手术的医院。符合分析条件的数据是 2009 年至 2016 年间的原发性切除术数据。患者被分为六类：体重不足、正常体重、超重和肥胖 I 级、II 级和 III 级。
在 71084 名患者中，17.7%的结肠癌和 16.4%的直肠癌患者被归类为肥胖。肥胖 CRC 患者的 30 天总体术后并发症发生率（p<0.001）、住院时间延长（p<0.001）和再入院率（结肠癌 p<0.005；直肠癌 p<0.002）存在显著差异。多变量分析确定 BMI≥30kg/m2是 CRC 患者术后并发症的独立预测因素。此外，肥胖相关合并症与更高的术后发病率、住院时间延长和更高的再入院率相关。在接受减重手术的医院和未接受减重手术的医院之间，肥胖 CRC 患者术后结局的表现没有显著差异。
本研究分析的真实数据反映了荷兰的日常实践，并确定肥胖是 CRC 患者的一个重要危险因素。肥胖相关合并症与肥胖 CRC 患者更高的术后发病率、住院时间延长和更高的再入院率相关。在接受减重手术的医院和未接受减重手术的医院之间，没有观察到差异。
