Effect of obesity on post-operative outcomes following colorectal cancer surgery

doi:10.4251/wjgo.v14.i7.1324

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World Journal of Gastrointestinal Oncology

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Retrospective Study

World J Gastrointest Oncol. Jul 15, 2022; 14(7): 1324-1336
Published online Jul 15, 2022. doi: 10.4251/wjgo.v14.i7.1324

Table 1 Demographic and co-morbidity characteristics of patients undergoing colorectal cancer surgery

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		433	182	615
Age		71 (58.0-79.0)	70 (60.0-77.0)		0.45
Sex	Male	232 (53.6)	83 (45.6)	315	0.08
Sex	Female	201 (46.4)	99 (54.4)	300	0.08
ASA grade	Low (ASA 1-2)	198 (45.7)	54 (29.7)	252	< 0.001
ASA grade	High (ASA ≥ 3)	235 (54.3)	128 (70.3)	363	< 0.001
Any cardiac comorbidity		246 (56.8)	133 (73.1)	379	< 0.001
Specified cardiac comorbidity	Ischemic heart disease	79 (18.2)	37 (20.3)	116	0.57
	Coronary artery bypass graft	25 (5.8)	16 (8.8)	41	0.21
	Coronary stents	25 (5.8)	15 (8.2)	40	0.28
	Pacemaker	8 (1.8)	5 (2.7)	13	0.54
	Valve replacement	19 (4.4)	4 (2.2)	23	0.25
	Heart failure	19 (4.4)	9 (4.9)	28	0.83
	Hypertension	186 (43.0)	117 (64.3)	303	< 0.001
	Atrial fibrillation	54 (12.5)	29 (15.9)	83	0.25
Any respiratory comorbidity		116 (26.8)	68 (37.4)	184	0.01
Specified respiratory comorbidity	Asthma	41 (9.5)	27 (14.8)	68	0.07
	Chronic obstructive pulmonary disease	52 (12.0)	20 (11.0)	72	0.78
	Bronchiectasis	6 (1.4)	3 (1.6)	9	0.73
	Obstructive sleep apnea	10 (2.3)	26 (14.3)	36	< 0.001
Any metabolic comorbidity		158 (36.5)	182 (100.0)	340	< 0.001
Specified metabolic comorbidity	Type 1 diabetes mellitus	3 (0.7)	0 (0.0)	3	0.56
	Type 2 diabetes mellitus	55 (12.7)	52 (28.6)	107	< 0.001
	Hyperlipidemia	116 (26.8)	59 (32.4)	175	0.17
Current smoker		67 (15.5)	25 (13.8)	92	0.71
Alcohol > 2 standard drinks/d		44 (10.2)	13 (7.1)	57	0.29

ASA: American Society of Anesthesiologists; BMI: Body mass index.

Table 2 Surgical features of patients undergoing colorectal cancer surgery

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		433	182	615
Cancer location	Appendix	37 (8.5)	9 (4.9)	46	0.47
	Cecum to transverse colon	205 (47.3)	92 (50.5)	297
	Splenic flexure to sigmoid colon	143 (33.0)	61 (33.5)	204
	Rectum	48 (11.1)	20 (11.0)	68
Operative urgency	Elective	359 (82.9)	161 (88.5)	519	0.09
Operative urgency	Emergency	74 (17.1)	21 (11.5)	95	0.09
Operative approach	Laparoscopic	265 (61.5)	96 (53.3)	361	0.002
	Open	72 (16.7)	20 (11.1)	92
	Laparoscopic-assisted	71 (16.5)	40 (22.2)	111
	Laparoscopic converted to open	22 (5.1)	23 (12.8)	45
	Transanal excision	1 (0.2)	1 (0.2)	2
Operation performed	Appendicectomy	31 (7.2)	8 (4.4)	39	0.18
	Right hemicolectomy	170 (39.3)	74 (40.7)	244
	Extended right hemicolectomy	34 (7.9)	18 (9.9)	52
	Left hemicolectomy	18 (4.2)	11 (6.0)	29
	Hartmann’s procedure	20 (4.6)	5 (2.7)	25
	High anterior resection	76 (17.6)	37 (20.3)	113
	Low anterior resection	27 (6.2)	9 (4.9)	36
	Ultra-low anterior resection	28 (6.5)	5 (2.7)	33
	Other	29 (6.7)	15 (8.2)	44
Stoma requirement		65 (15.0)	18 (9.9)	83	0.09
Peri-operative transfusion requirement		65 (15.0)	28 (15.4)	93	0.90

BMI: Body mass index.

Table 3 Post-operative outcomes of patients undergoing colorectal cancer surgery

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		433	182	615
Post-operative complication (CD grade)	No complication	242 (55.9)	88 (48.4)	330	0.06
	Complication	191 (44.1)	94 (51.6)	285
	I	31 (7.2)	17 (9.3)	48
	II	99 (22.9)	42 (23.1)	141
	IIIa	27 (6.2)	15 (8.2)	42
	IIIb	13 (3.0)	6 (3.3)	19
	IVa	13 (3.0)	10 (5.5)	23
	IVb	0 (0.0)	3 (1.6)	3
	V	8 (1.8)	1 (0.5)	9
	No complication or low-grade complication (CD I-II)	372 (85.9)	147 (80.8)	519	0.11
	High-grade complication (CD IIIa-V)	61 (14.1)	35 (19.2)	96	0.11
Any surgical complication		99 (22.9)	48 (26.4)	147	0.35
Specified surgical complications	Abdomino-pelvic collection	16 (3.7)	3 (1.6)	19	0.21
	Anastomotic leak	12 (2.8)	7 (3.8)	19	0.46
	Wound infection	19 (4.4)	7 (3.8)	26	0.83
	Prolonged ileus	49 (11.3)	27 (14.8)	76	0.23
	Post-operative hemorrhage	3 (0.7)	2 (1.1)	5	0.64
	Return to theatre	13 (3.0)	7 (3.8)	20	0.62
	Post-operative sepsis	16 (8.3)	8 (8.6)	24	1.00
Any medical complication		96 (22.2)	37 (20.3)	133	0.67
Specified medical complications	VTE (DVT/PE)	4 (0.9)	2 (1.1)	6	1.00
	Pneumonia	19 (4.4)	8 (4.4)	27	1.00
	Ischemic cardiac event	5 (1.2)	5 (2.7)	10	0.17
	Cardiac arrhythmia	30 (6.9)	9 (4.9)	39	0.47
	Respiratory failure	10 (2.3)	8 (4.4)	18	0.19
	Renal failure	12 (2.8)	7 (3.8)	19	0.46
	Unplanned ICU admission	16 (3.7)	6 (3.3)	22	1.00
Post-operative length of stay (d)		6 (IQR 5-11)	7 (IQR 5-11)		0.42

BMI: Body mass index; CD: Clavien-Dindo; DVT: Deep vein thrombosis; ICU: Intensive care unit; IQR: Interquartile range; PE: Pulmonary embolism; VTE: Venous thrombo-embolism.

Table 4 Post-operative outcomes in the subgroup of patients undergoing laparoscopic colorectal cancer surgery

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		336	136	472
Post-operative complication (CD grade)	No complication	204 (60.7)	71 (52.2)	275	0.05
	Complication	132 (39.3)	65 (47.8)	197
	I	24 (7.1)	12 (8.8)	36
	II	71 (21.1)	29 (21.3)	100
	IIIa	20 (6.0)	10 (7.4)	30
	IIIb	6 (1.8)	6 (4.4)	12
	IVa	6 (1.8)	6 (4.4)	12
	IVb	0 (0.0)	2 (1.5)	2
	V	5 (1.5)	0 (0.0)	5
	No complication or low-grade complication (CD I-II)	299 (89.0)	112 (82.4)	411	0.07
	High-grade complication (CD IIIa-V)	37 (11.0)	24 (17.6)	61	0.07
Any surgical complication		68 (20.2)	37 (27.2)	105	0.11
Specified surgical complications	Abdomino-pelvic collection	9 (2.7)	3 (2.2)	12	1.00
	Anastomotic leak	7 (2.1)	5 (3.7)	12	0.34
	Wound infection	13 (3.9)	6 (4.4)	19	0.80
	Prolonged ileus	33 (9.8)	21 (15.4)	54	0.11
	Post-operative hemorrhage	2 (0.6)	1 (0.7)	3	1.00
	Return to theatre	6 (1.8)	6 (4.4)	12	0.11
	Post-operative sepsis	12 (9.0)	4 (6.2)	16	0.59
Any medical complication		66 (19.6)	21 (15.4)	87	0.36
Specified medical complications	VTE (DVT/PE)	3 (0.9)	1 (0.7)	4	1.00
	Pneumonia	13 (3.9)	2 (1.5)	15	0.25
	Ischemic cardiac event	3 (0.9)	3 (2.2)	6	0.36
	Cardiac arrhythmia	23 (6.8)	7 (5.1)	30	0.68
	Respiratory failure	7 (2.1)	6 (4.4)	13	0.21
	Renal failure	7 (2.1)	4 (2.9)	11	0.52
	Unplanned ICU admission	6 (1.8)	3 (2.2)	9	0.72
Post-operative length of stay (d)		6 (IQR 4-9)	6 (IQR 5-10)		0.15

BMI: Body mass index; CD: Clavien-Dindo; DVT: Deep vein thrombosis; ICU: Intensive care unit; IQR: Interquartile range; PE: Pulmonary embolism; VTE: Venous thrombo-embolism.

Table 5 Post-operative outcomes in the subgroup of patients with right sided colon cancer

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		205	92	297
Post-operative complication (CD grade)	No complication	94 (45.9)	44 (47.8)	138	0.61
	Complication	111 (54.1)	48 (52.2)	159
	I	21 (10.2)	9 (9.8)	30
	II	58 (28.3)	23 (25.0)	81
	IIIa	19 (9.3)	7 (7.6)	26
	IIIb	3 (1.5)	1 (1.1)	4
	IVa	8 (3.9)	5 (5.4)	13
	IVb	0 (0.0)	2 (2.2)	2
	V	2 (1.0)	1 (1.1)	3
	No complication or low-grade complication (CD I-II)	173 (84.4)	76 (82.6)	249	0.73
	High-grade complication (CD IIIa-V)	32 (15.6)	16 (17.4)	48	0.73
Any surgical complication		52 (25.4)	22 (23.9)	74	0.88
Specified surgical complications	Abdomino-pelvic collection	7 (3.4)	3 (0.0)	10	0.10
	Anastomotic leak	7 (3.4)	0 (0.0)	7	1.00
	Wound infection	10 (4.9)	3 (3.3)	13	0.76
	Prolonged ileus	26 (12.7)	14 (15.2)	40	0.58
	Post-operative hemorrhage	1 (0.5)	2 (2.2)	3	0.23
	Return to theatre	3 (1.5)	1 (1.1)	4	1.00
	Post-operative sepsis	2 (1.0)	1 (1.1)	3	1.00
Any medical complication		55 (26.8)	25 (27.2)	80	1.00
Specified medical complications	VTE (DVT/PE)	2 (1.0)	1 (1.1)	3	1.00
	Pneumonia	14 (6.8)	6 (6.5)	20	1.00
	Ischemic cardiac event	2 (1.0)	3 (3.3)	5	0.17
	Cardiac arrhythmia	20 (9.8)	6 (6.5)	26	0.51
	Respiratory failure	4 (2.0)	5 (5.4)	9	0.14
	Renal failure	7 (3.4)	6 (6.5)	13	0.23
	Unplanned ICU admission	8 (3.9)	4 (4.3)	12	1.00
Post-operative length of stay (d)		7 (IQR 5-11)	6 (IQR 5-11)		0.91

BMI: Body mass index; CD: Clavien-Dindo; DVT: Deep vein thrombosis; IQR: Interquartile range; PE: Pulmonary embolism; VTE: Venous thrombo-embolism.

Table 6 Post-operative outcomes in the subgroup of patients with left sided colon cancer

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		143	61	204
Post-operative complication (CD grade)	No complication	90 (62.9)	32 (52.5)	122	0.09
	Complication	53 (37.1)	29 (47.5)	82
	I	7 (4.9)	6 (9.8)	13
	II	32 (22.4)	12 (19.7)	44
	IIIa	3 (2.1)	6 (9.8)	9
	IIIb	5 (3.5)	2 (3.3)	7
	IVa	3 (2.1)	2 (3.3)	5
	IVb	0 (0.0)	1 (1.6)	1
	V	3 (2.1)	0 (0.0)	3
	No complication or low-grade complication (CD I-II)	129 (90.2)	50 (82.0)	179	0.11
	High-grade complication (CD IIIa-V)	14 (9.8)	11 (18.0)	25	0.11
Any surgical complication		29 (20.3)	17 (27.9)	46	0.27
Specified surgical complications	Abdomino-pelvic collection	7 (4.9)	2 (3.3)	9	0.73
	Anastomotic leak	4 (2.8)	2 (3.3)	6	1.00
	Wound infection	4 (2.8)	3 (4.9)	7	0.43
	Prolonged ileus	17 (11.9)	9 (14.8)	26	0.65
	Post-operative hemorrhage	1 (0.7)	0 (0.0)	1	1.00
	Return to theatre	5 (3.5)	3 (4.9)	8	0.70
	Post-operative sepsis	3 (2.1)	0 (0.0)	3	0.56
Any medical complication		28 (19.6)	6 (9.8)	34	0.10
Specified medical complications	VTE (DVT/PE)	1 (0.7)	1 (1.6)	2	0.51
	Pneumonia	5 (3.5)	2 (3.3)	7	1.00
	Ischemic cardiac event	1 (0.7)	0 (0.0)	1	1.00
	Cardiac arrhythmia	6 (4.2)	0 (0.0)	6	1.00
	Respiratory failure	4 (2.8)	2 (3.3)	6	1.00
	Renal failure	4 (2.8)	0 (0.0)	4	0.32
	Unplanned ICU admission	5 (3.5)	2 (3.3)	7	1.00
Post-operative length of stay (d)		7 (IQR 5-10)	7 (IQR 5-10)		0.89

BMI: Body mass index; CD: Clavien-Dindo; DVT: Deep vein thrombosis; IQR: Interquartile range; PE: Pulmonary embolism; VTE: Venous thrombo-embolism.

Table 7 Post-operative outcomes in the subgroup of patients with rectal cancer

		BMI < 30 (% of group)	BMI ≥ 30 (% of group)	Total	P value
Patients		48	20	68
Post-operative complication (CD grade)	No complication	22 (45.8)	6 (30.0)	28	0.68
	Complication	26 (54.2)	14 (70.0)	40
	I	3 (6.3)	2 (10.0)	5
	II	8 (16.7)	5 (25.0)	13
	IIIa	5 (10.4)	2 (10.0)	7
	IIIb	5 (10.4)	3 (15.0)	8
	IVa	2 (4.2)	2 (10.0)	4
	IVb	0 (0.0)	0 (0.0)	0
	V	3 (6.3)	0 (0.0)	3
	No complication or low-grade complication (CD I-II)	33 (68.8)	13 (65.0)	46	0.78
	High-grade complication (CD IIIa-V)	15 (31.2)	7 (35.0)	22	0.78
Any surgical complication		18 (37.5)	7 (35.0)	25	1.00
Specified surgical complications	Abdomino-pelvic collection	2 (4.2)	1 (5.0)	3	1.00
	Anastomotic leak	1 (2.1)	2 (10.0)	3	0.20
	Wound infection	5 (10.4)	0 (0.0)	5	0.31
	Prolonged ileus	6 (12.5)	3 (15.0)	9	1.00
	Post-operative hemorrhage	1 (2.1)	0 (0.0)	1	1.00
	Return to theatre	5 (10.4)	3 (15.0)	8	0.68
	Post-operative sepsis	1 (2.1)	0 (0.0)	1	1.00
Any medical complication		13 (27.1)	5 (25.0)	18	1.00
Specified medical complications	VTE (DVT/PE)	1 (2.1)	0 (0.0)	1	1.00
	Pneumonia	0 (0.0)	0 (0.0)	0
	Ischemic cardiac event	2 (4.2)	2 (10.0)	4	0.58
	Cardiac arrhythmia	4 (8.3)	2 (10.0)	6	1.00
	Respiratory failure	2 (4.2)	1 (5.0)	3	1.00
	Renal failure	1 (2.1)	1 (5.0)	2	0.50
	Unplanned ICU admission	3 (6.3)	0 (0.0)	3	0.55
Post-operative length of stay (d)		9 (IQR 6-14)	10 (IQR 5-21)		0.91

BMI: Body mass index; CD: Clavien-Dindo; DVT: Deep vein thrombosis; IQR: Interquartile range; PE: Pulmonary embolism; VTE: Venous thrombo-embolism.

Citation: Mao D, Flynn DE, Yerkovich S, Tran K, Gurunathan U, Chandrasegaram MD. Effect of obesity on post-operative outcomes following colorectal cancer surgery. World J Gastrointest Oncol 2022; 14(7): 1324-1336
URL: https://www.wjgnet.com/1948-5204/full/v14/i7/1324.htm
DOI: https://dx.doi.org/10.4251/wjgo.v14.i7.1324