Oncologic Evaluation of Obesity As a Factor in Patients with Rectal Cancer Undergoing Laparoscopic Surgery: a Propensity-matched Analysis Using Body Mass Index

Purpose: This study evaluated the oncologic impact of obesity, as determined by body mass index (BMI), in patients who underwent laparoscopic surgery for rectal cancer.

Methods: The records of 483 patients with stage I-III rectal cancer who underwent laparoscopic surgery between June 2003 and December 2011 were reviewed. A matching model based on BMI was constructed to balance obese and nonobese patients. Cox hazard regression models for overall survival (OS) and disease-free survival (DFS) were used for multivariate analyses. Additional analysis using visceral fat area (VFA) measurement was performed for matched patients. The threshold for obesity was BMI ≥ 25 kg/m or VFA ≥ 130 cm.

Results: The score matching model yielded 119 patients with a BMI ≥ 25 kg/m (the obese group) and 119 patients with a BMI < 25 kg/m (the nonobese group). Surgical outcomes including operation time, estimated blood loss, nil per os periods, and length of hospital stay did not differ between the obese and the nonobese group. The retrieved lymph node numbers and pathologic CRM positive rate were also similar in between the 2 groups. After a median follow-up of 48 months (range, 3-126 months), OS and DFS rates were similar between the 2 groups. A tumor location-adjusted model for overall surgical complications showed that a BMI ≥ 25 kg/m were not risk factors. Multivariable analyses for OS and DFS showed no significant association with a BMI ≥ 25 kg/m.

Conclusion: Obesity was not associated with long-term oncologic outcomes in patients undergoing laparoscopic surgery for rectal cancer in the Asian population.