The Impact of Obesity on Outcomes of Laparoscopic Surgery for Colorectal Cancer in Asians

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2009 Dec 30

PMID 20039065

Citations 40

Authors

Ji Won Park

Sang-Woo Lim

Hyo Seong Choi

Seung-Yong Jeong

Jae Hwan Oh

Seok-Byung Lim

Affiliations

Soon will be listed here.

Abstract

Background: The influence of obesity on surgical outcomes after laparoscopic colorectal surgery in Asian patients is unclear. The aim of this study was to evaluate the feasibility and safety of laparoscopic surgery in obese Asian patients with colorectal cancer.

Methods: We retrospectively reviewed the prospectively collected data on 984 consecutive patients who underwent laparoscopic surgery for colorectal cancer between May 2001 and February 2008. Patients were classified according to the categories proposed by the International Obesity Task Force, as Nonobese (body mass index [BMI] < 25.0 kg/m(2)), Obese I (BMI 25.0-29.9 kg/m(2)), and Obese II (BMI > or = 30 kg/m(2)). Surgical outcomes, including open conversion, operation time, postoperative complications, estimated blood loss, and postoperative hospital stay, were compared in Nonobese, Obese I, and Obese II patients.

Results: Of the 984 patients, 645 (65.5%), 312 (31.7%), and 27 (2.7%), were classified as Nonobese, Obese I, and Obese II, respectively. Clinicopathologic characteristics were similar among the three groups. The Obese II group had higher conversion rates (14.8% versus 2.6% and 2.9%, P = 0.001), longer operation time (258 versus 201 and 215 min, P = 0.001), and longer postoperative hospital stay (12.1 versus 9.5 and 9.2 days, P = 0.035) than the Nonobese and Obese I groups. However, the rates of intraoperative events (P = 0.634) and postoperative complications (P = 0.603) were similar in nonobese and obese patients. Independent risk factors for conversion were BMI group and operation type. Obese II patients had an 8.36-fold greater risk of conversion than had Nonobese patients (P = 0.001).

Conclusions: With sufficient experience, laparoscopic colorectal surgery in obese Asian patients is feasible and safe, offering all the benefits of a minimally invasive approach. Management of Asian colorectal cancer patients with BMI > or = 30 kg/m(2) requires meticulous perioperative care, and colorectal surgeons must be familiar with obesity-related challenges in such patients.

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References

Thorpe H, Jayne D, Guillou P, Quirke P, Copeland J, Brown J . Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg. 2007; 95(2):199-205. DOI: 10.1002/bjs.5907. View

Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S . A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350(20):2050-9. DOI: 10.1056/NEJMoa032651. View

Lascano C, Kaidar-Person O, Szomstein S, Rosenthal R, Wexner S . Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg. 2006; 192(3):357-65. DOI: 10.1016/j.amjsurg.2006.04.011. View

Ishii Y, Hasegawa H, Nishibori H, Watanabe M, Kitajima M . Impact of visceral obesity on surgical outcome after laparoscopic surgery for rectal cancer. Br J Surg. 2005; 92(10):1261-2. DOI: 10.1002/bjs.5069. View

Senagore A, Delaney C, Madboulay K, Brady K, Fazio V, Fazio C . Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003; 7(4):558-61. DOI: 10.1016/s1091-255x(02)00124-5. View

Veldkamp R, Kuhry E, Hop W, Jeekel J, Kazemier G, Bonjer H . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005; 6(7):477-84. DOI: 10.1016/S1470-2045(05)70221-7. View

Pikarsky A, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss E . Is obesity a high-risk factor for laparoscopic colorectal surgery?. Surg Endosc. 2002; 16(5):855-8. DOI: 10.1007/s004640080069. View

Buchanan G, Malik A, Parvaiz A, Sheffield J, Kennedy R . Laparoscopic resection for colorectal cancer. Br J Surg. 2008; 95(7):893-902. DOI: 10.1002/bjs.6019. View

Gendall K, Raniga S, Kennedy R, Frizelle F . The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007; 50(12):2223-37. DOI: 10.1007/s10350-007-9051-0. View

10.

Seki Y, Ohue M, Sekimoto M, Takiguchi S, Takemasa I, Ikeda M . Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc. 2007; 21(6):929-34. DOI: 10.1007/s00464-006-9084-9. View

11.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

12.

Schwandner O, Farke S, Schiedeck T, Bruch H . Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes?. Surg Endosc. 2005; 18(10):1452-6. DOI: 10.1007/s00464-003-9259-6. View

13.

Stevens J, Nowicki E . Body mass index and mortality in asian populations: implications for obesity cut-points. Nutr Rev. 2003; 61(3):104-7. DOI: 10.1301/nr.2003.marr.104-107. View

14.

Dindo D, Muller M, Weber M, Clavien P . Obesity in general elective surgery. Lancet. 2003; 361(9374):2032-5. DOI: 10.1016/S0140-6736(03)13640-9. View

15.

Dostalik J, Martinek L, Vavra P, Andel P, Gunka I, Gunkova P . Laparoscopic colorectal surgery in obese patients. Obes Surg. 2005; 15(9):1328-31. DOI: 10.1381/096089205774512447. View

16.

Tuech J, Regenet N, Hennekinne S, Pessaux P, Bergamaschi R, Arnaud J . Laparoscopic colectomy for sigmoid diverticulitis in obese and nonobese patients: a prospective comparative study. Surg Endosc. 2002; 15(12):1427-30. DOI: 10.1007/s00464-001-9023-8. View

17.

Lim S, Choi H, Jeong S, Park J . Feasibility of laparoscopic techniques as the surgical approach of choice for primary colorectal cancer: an analysis of 570 consecutive cases. Surg Endosc. 2008; 22(12):2588-95. DOI: 10.1007/s00464-008-9814-2. View

18.

Loffer F, PENT D . Laparoscopy in the obese patient. Am J Obstet Gynecol. 1976; 125(1):104-7. DOI: 10.1016/0002-9378(76)90902-9. View

19.

Schlachta C, Mamazza J, Gregoire R, Burpee S, Pace K, Poulin E . Predicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage. Surg Endosc. 2003; 17(8):1288-91. DOI: 10.1007/s00464-002-8920-9. View

20.

Delaney C, Pokala N, Senagore A, Casillas S, Kiran R, Brady K . Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum. 2005; 48(5):975-81. DOI: 10.1007/s10350-004-0941-0. View