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Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes.

ABSTRACT: BACKGROUND:Quantitative computed tomography (CT) assessment of visceral adiposity may be superior to body mass index (BMI) as a predictor of surgical morbidity. We sought to examine the association of CT measures of obesity and BMI with short-term postoperative outcomes in colon cancer patients. METHODS:In this retrospective study, 110 patients treated with colectomy for stage I-III colon cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity or BMI [obese: BMI???30 kg/m2, visceral fat area (VFA) to subcutaneous fat area ratio (V/S) ?0.4, and VFA?>?100 cm2]. Postoperative morbidity and mortality rates were compared. RESULTS:Obese patients, by V/S and VFA but not BMI, were more likely to be male and have preexisting hypertension and diabetes. The overall complication rate was 25.5%, and there were no mortalities. Obese patients by VFA (with a trend for V/S but not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese: VFA (30.5 vs.10.7%, p?=?0.03), V/S (29.2 vs. 9.5%, p?=?0.05), and BMI (32.4 vs. 21.9%, p?=?0.23). CONCLUSIONS:Elevated visceral obesity quantified by CT is associated with the presence of key metabolic comorbidities and increased postoperative morbidity and may be superior to BMI for risk stratification.

SUBMITTER: Ozoya OO

PROVIDER: S-EPMC5560865 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes.

Ozoya Oluwatobi O OO Siegel Erin M EM Srikumar Thejal T Bloomer Amanda M AM DeRenzis Amanda A Shibata David D

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 20170118 3

<h4>Background</h4>Quantitative computed tomography (CT) assessment of visceral adiposity may be superior to body mass index (BMI) as a predictor of surgical morbidity. We sought to examine the association of CT measures of obesity and BMI with short-term postoperative outcomes in colon cancer patients.<h4>Methods</h4>In this retrospective study, 110 patients treated with colectomy for stage I-III colon cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity o ...[more]

PMID: 28101721

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Project description:BackgroundThe impact of obesity on postoperative outcomes after pancreatoduodenectomy remains insufficiently studied.MethodsAll pancreatoduodenectomy patients were abstracted from the 2014 to 2018 American College of Surgeons National Surgical Quality Improvement Program data sets and were stratified into the following 3 body mass index categories: non-obese (body mass index 18.5-29.9), class 1/2 obesity (body mass index 30-39.9), and class 3 severe obesity (body mass index ≥ 40). Analyses tested associations between patient factors and four 30-day postoperative outcomes: mortality, composite morbidity, delayed gastric emptying, and postoperative pancreatic fistula. Multivariable logistic regression models tested independent associations between patient factors and these 4 outcome measures.ResultsA total of 16,823 patients were included in the study: 12,234 (72.7%) non-obese, 4,030 (24%) obese, and 559 (3.3%) with severe obesity. Bivariable analyses demonstrated significant associations between obesity, severe obesity, and greater proportions of numerous preoperative comorbidities as well as a greater likelihood of postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, composite morbidity, and mortality (all P ≤ .001). After adjusting for significant covariates, obesity was independently associated with postoperative pancreatic fistula (odds ratio 1.49, 95% confidence interval: 1.33-1.67, P < .001), delayed gastric emptying (odds ratio 1.16, 95% confidence interval: 1.05-1.28, P = .004), composite morbidity (odds ratio 1.28, 95% confidence interval: 1.18-1.38, P < .001), and mortality (odds ratio 1.79, 95% confidence interval: 1.36-2.36, P < .001).ConclusionObesity and severe obesity are significantly associated with worse short-term outcomes after pancreatoduodenectomy. Preoperative considerations, such as weight management strategies during individualized treatment planning, could improve outcomes in this population.

Project description:The gut microbiota is crucial in the pathogenesis of obesity. Abdominal obesity is known to significantly increase the risk of metabolic syndrome and cardiovascular disease, so further study is needed to investigate the changes of intestinal microorganisms in patients with excessive visceral fat. In our study, 41 people (n = 41) with normal body mass index (BMI) (18.5 ≤ BMI < 23.9) were included and divided into the low visceral fat area (L-VFA) group (n = 23, VFA < 100 cm2) and the high visceral fat area (H-VFA) group (n = 18, VFA ≥ 100 cm2). Several clinical indicators of the H-VFA group were significantly higher than those of the L-VFA group, including the waist circumference (WC), the fasting blood glucose (FBG), the triglyceride (TG), the total cholesterol (TC), the low-density lipoprotein cholesterol (LDL), the serum uric acid (SUA), the white blood cell count (WBC), the blood neutrophil count (NEC), and the blood lymphocyte count (LYC). Using whole-genome shotgun sequencing, we found that the types of the intestinal microbiota of H-VFA patients were different from those of the L-VFA patients, with 18 bacteria enriched in the H-VFA group and nine bacteria in the L-VFA group. A total of 16 species of gut microbes showed a strong correlation with VFA, and Escherichia coli has the strongest correlation, followed by Mitsuokella unclassified, Bifidobacterium longum, Escherichia unclassified, Ruminococcus torques, Dialister succinatiphilus, Eubacterium hallii, and Ruminococcus gnavus. Compared to the VFA, only two species show a strong correlation with BMI and WC. Further functional genetic studies suggested that the degradation of short-chain fatty acids (SCFAs) and the generation of lipopolysaccharide (LPS) might be related to visceral fat accumulation. Together, visceral fat was more closely correlated with the gut microbiome compared with BMI and WC. It suggested an intrinsic connection between the gut microbiome and visceral fat and its related metabolic disorders. Specific microbial species and pathways associated with visceral fat accumulation might contribute to new targeted therapies for visceral fat and its metabolic disorders.

Project description:BackgroundColon cancer, a significant contributor to cancer-related mortality worldwide, exhibits a high recurrence rate in patients following surgical intervention, particularly when the disease has progressed to intermediate or advanced stages. This study undertakes a comprehensive analysis of the risk factors influencing postoperative recurrence in patients with middle- to late-stage colon cancer and subsequently develops a columnar graphical prediction model based on these findings. This model seeks to enhance the capability of identifying the risk of postoperative recurrence in patients with intermediate and advanced colon cancer, thereby providing a scientific foundation for the development of more personalized and effective prevention and management strategies.MethodsAn analysis was conducted on a cohort of 209 patients diagnosed with colon cancer and treated at our hospital between 2020 and 2021. Clinical data were gathered to compare recurrence rates of postoperative colon cancer among patients with different influencing factors. Logistic regression analysis was utilized to determine independent factors affecting the recurrence rate of postoperative colon cancer. A nomogram risk prediction model was developed and assessed for its effectiveness.ResultsThe results of the regression analysis indicated that "Tumor stage" (stage IV), "Lymph node metastasis" (presence), "the level of C-reactive protein", and "the level of carcinoembryonic antigen" were identified as independent risk factors for postoperative colon cancer recurrence in patients. Additionally, "Differentiation degree" (medium/high), "Chemotherapy (have)", and "the level of serum albumin" were found to be associated with a decreased risk of recurrence. A nomogram prediction model was created using the mentioned risk factors, showing a link between higher scores and higher postoperative colon cancer recurrence rates. The model had a C-index of 0.834 [95% confidence interval (CI): 0.776-0.892] and was internally validated for strong and consistent performance.ConclusionsThis study developed a nomogram prediction model to forecast the recurrence rate of postoperative colon cancer by identifying independent influencing factors. The model demonstrates strong discrimination and consistency, offering valuable guidance in promptly assessing the likelihood of postoperative colon cancer recurrence in patients and implementing timely and effective preventive measures.

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Dataset Information

Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes.

Publications

Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes.

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