Heus C, Bakker N, Verduin W M, Doodeman H J, Houdijk A P J
Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
Department of Gynaecology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
World J Surg. 2019 May;43(5):1370-1376. doi: 10.1007/s00268-019-04925-z.
Obesity is becoming a bigger health problem every year. Current research shows that the obesity-related metabolic problems are strongly associated with visceral fat and not subcutaneous fat. Visceral obesity (VO) is associated with a worse postoperative outcome in multiple fields of abdominal surgery. On the other hand, muscle mass is related to better postoperative outcome. In rectal cancer patients, we studied the influence of visceral obesity and muscle mass on postoperative complications.
The visceral fat area (VFA) and skeletal muscle area (SMA) were determined on preoperative CT scans in 406 patients. The preoperative comorbidity, per-operative outcome and postoperative complications were extracted retrospectively from the patient files. VO was defined as a VFA > 100 cm. Correlations between body composition, postoperative complications and LOS were studied.
In our study, 67% of the patients were classified as visceral obese. Mean body mass index (BMI) was higher in the VO group (26.6 ± 3.5 vs 23.5 ± 2.8; p < 0.001). Visceral obese patients had a higher prevalence of cardiac comorbidity (29% vs 13% p = 0.001), hypertension (36% vs 20% p = 0.002) and diabetes mellitus (16% vs 5% p = 0.002). In addition, VO patients had more operative blood loss (431 vs 310 mL; p = 0.008), longer operating time (166 vs 149 min p = 0.003) and more wound infections (14% vs 8% p = 0.048). Visceral obesity was associated with more complications (OR: 1.63 p = 0.043) and longer LOS (risk estimate: 1.18 p = 0.009).
VO patients more often had a history of cardiac disease, hypertension and diabetes mellitus. Visceral obesity correlated with a worse outcome after surgery for rectal cancer.
肥胖正日益成为一个严重的健康问题。目前的研究表明，与肥胖相关的代谢问题与内脏脂肪密切相关，而非皮下脂肪。内脏型肥胖（VO）与腹部外科多个领域术后较差的预后相关。另一方面，肌肉量与较好的术后预后相关。在直肠癌患者中，我们研究了内脏型肥胖和肌肉量对术后并发症的影响。
对406例患者术前CT扫描测定内脏脂肪面积（VFA）和骨骼肌面积（SMA）。回顾性提取患者病历中的术前合并症、术中结果和术后并发症。VO定义为VFA>100 cm²。研究身体成分、术后并发症和住院时间之间的相关性。
在我们的研究中，67%的患者被归类为内脏型肥胖。VO组的平均体重指数（BMI）更高（26.6±3.5 vs 23.5±2.8；p<0.001）。内脏型肥胖患者心脏合并症（29% vs 13%，p = 0.001）、高血压（36% vs 20%，p = 0.002）和糖尿病（16% vs 5%，p = 0.002）的患病率更高。此外，VO患者术中失血量更多（431 vs 310 mL；p = 0.008），手术时间更长（166 vs 149分钟，p = 0.003），伤口感染更多（14% vs 8%，p = 0.048）。内脏型肥胖与更多并发症（OR：1.63，p = 0.043）和更长的住院时间（风险估计：1.18，p = 0.009）相关。
VO患者更常患有心脏病、高血压和糖尿病史。内脏型肥胖与直肠癌手术后较差的预后相关。
