Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany,
Department of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
Obes Facts. 2019;12(3):259-271. doi: 10.1159/000499320. Epub 2019 May 3.
Obesity is associated with increased incidence and mortality in rectal cancer (RC). However, an obesity paradox in the sense of a protective effect of obesity is discussed controversially. We evaluated whether adipose tissue distribution has an impact on medical (MC) and surgical complications (SC) after RC surgery.
A total of 296 RC patients underwent oncological surgery and multidetector CT with quantification of total (TAT), visceral (VAT), and subcutaneous adipose tissue (SAT). Logistic regressions on SC (anastomotic leakage [n = 26], wound infection [n = 58], bleeding [n = 12], abscess [n = 32], bladder dysfunction [n = 24], burst abdomen [n = 10]), and MC (pulmonary [n = 22], cardiac [n = 18], urinary tract infection [n = 9], sepsis [n = 5]) were performed.
High pelvicVAT was associated with reduced risk for overall SC (OR = 0.915, p = 0.012) and anastomotic leakage (OR = 0.587, p = 0.024, CI: 0.369/0.934). In contrast, CT-quantified obesity was associated with increased risk for wound infection, bladder dysfunction, burst abdomen, overall MC, and cardiac complications (ORs up to 1.423). BMI was not associated with any SC or MC.
An obesity paradox with a protective effect of CT-quantified adipose tissue was confirmed for anastomotic leakage and overall SC. In contrast, high adipose tissue was associated with higher risk for other SC and MC. These results show a more complex influence of body composition on MC and SC. CT-quantified obesity is able to provide deeper insights to explain the obesity paradox beyond BMI.
肥胖与直肠癌（RC）发病率和死亡率增加有关。然而，肥胖悖论（即肥胖具有保护作用）的说法存在争议。我们评估了脂肪组织分布是否会对 RC 手术后的医疗（MC）和手术并发症（SC）产生影响。
共有 296 例 RC 患者接受了肿瘤外科手术和多排螺旋 CT 检查，并对总脂肪组织（TAT）、内脏脂肪组织（VAT）和皮下脂肪组织（SAT）进行了定量分析。对 SC（吻合口漏 [n=26]、伤口感染 [n=58]、出血 [n=12]、脓肿 [n=32]、膀胱功能障碍 [n=24]、暴发性腹部 [n=10]）和 MC（肺部 [n=22]、心脏 [n=18]、尿路感染 [n=9]、败血症 [n=5]）进行了逻辑回归分析。
高盆腔 VAT 与整体 SC（OR=0.915，p=0.012）和吻合口漏（OR=0.587，p=0.024，CI：0.369/0.934）风险降低相关。相反，CT 定量肥胖与伤口感染、膀胱功能障碍、暴发性腹部、整体 MC 和心脏并发症的风险增加相关（OR 高达 1.423）。BMI 与任何 SC 或 MC 均无相关性。
CT 定量脂肪组织的肥胖悖论具有保护作用，这在吻合口漏和整体 SC 中得到了证实。相反，高脂肪组织与其他 SC 和 MC 的风险增加相关。这些结果表明，身体成分对 MC 和 SC 的影响更为复杂。CT 定量肥胖能够提供更深入的见解，以解释 BMI 之外的肥胖悖论。
