Xu Simon, Gosavi Rathin, Chung Yat Cheung, Teoh William, Nguyen T C, Ooi Geraldine, Narasimhan Vignesh
Department of Colorectal Surgery, Monash Health, David Street, Dandenong, Melbourne, VIC, 3193, Australia.
Department of Colorectal Surgery, Cabrini Hospital, Melbourne, Australia.
Int J Colorectal Dis. 2025 Aug 25;40(1):188. doi: 10.1007/s00384-025-04989-5.
Obesity is traditionally viewed as a risk factor for adverse surgical outcomes. This study evaluated whether obesity (BMI ≥ 30 kg/m) independently affected intraoperative and postoperative outcomes following colon cancer resection, and whether these effects varied by anatomical site.
A retrospective cohort study was conducted of consecutive patients who underwent colon cancer resection at a single institution from 2015 to 2022. Patients were stratified by BMI (≥ 30 kg/m vs < 30 kg/m) and further grouped by urgency (elective or emergency) and anatomical subsite (right- vs left-sided). Primary outcomes were intraoperative complications, severe postoperative morbidity (Clavien-Dindo ≥ III), conversion to open surgery, ICU admission, and 30-day mortality. Multivariate logistic regression was used to adjust for confounders.
Among the 737 patients, 33.5% were obese (BMI ≥ 30). Obese patients were younger and had higher rates of hypertension (55% vs 46%, p = 0.01), diabetes (25% vs 16%, p < 0.01), and respiratory disease (22% vs 11%, p < 0.01). In the overall cohort, obesity was not associated with increased rates of intraoperative complications, severe postoperative complications, conversion to open surgery, or 30-day mortality. In elective resections, obesity was independently associated with increased likelihood of ICU admission (aOR 1.82, 95% CI 1.08-3.09; p = 0.02), while in emergent resections obesity was independently associated with higher intra-operative complications (aOR 2.18, 95% CI 1.19-3.97; p = 0.01). Stratified analysis by resection site revealed that obesity was an independent risk factor associated with intraoperative complications (aOR 1.89, 95% CI 1.03-3.47; p = 0.04) and ICU admission (aOR 3.17, 95% CI 1.61-6.23; p < 0.01) following left-sided colectomy, but not right-sided surgery.
Obesity was not associated with adverse outcomes following colon cancer surgery overall. However, when stratified by anatomical subsite, obesity was independently associated with increased perioperative risk in left-sided resections. These findings support a more nuanced approach to operative planning and perioperative risk stratification.
传统观点认为肥胖是手术不良结局的一个风险因素。本研究评估肥胖（BMI≥30kg/m²）是否独立影响结肠癌切除术后的术中及术后结局，以及这些影响是否因解剖部位而异。
对2015年至2022年在单一机构接受结肠癌切除术的连续患者进行一项回顾性队列研究。患者按BMI分层（≥30kg/m²与<30kg/m²），并进一步按手术紧迫性（择期或急诊）和解剖亚部位（右侧与左侧）分组。主要结局为术中并发症、严重术后并发症（Clavien-Dindo≥Ⅲ级）、转为开放手术、入住重症监护病房（ICU）以及30天死亡率。采用多因素逻辑回归对混杂因素进行校正。
在737例患者中，33.5%为肥胖患者（BMI≥30）。肥胖患者更年轻，高血压（55%对46%，p=0.01）、糖尿病（25%对16%，p<0.01）和呼吸系统疾病（22%对11%，p<0.01）的发生率更高。在整个队列中，肥胖与术中并发症、严重术后并发症、转为开放手术或30天死亡率的发生率增加无关。在择期切除术中，肥胖独立与入住ICU的可能性增加相关（校正比值比[aOR]1.82，95%置信区间[CI]1.08-3.09；p=0.02），而在急诊切除术中，肥胖独立与术中并发症发生率较高相关（aOR 2.18，95%CI 1.19-3.97；p=0.01）。按切除部位进行分层分析显示，肥胖是左侧结肠切除术后与术中并发症（aOR
