Visceral obesity exacerbates perioperative muscle loss and impairs survival in colorectal cancer

doi:10.4240/wjgs.v18.i5.116822

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. May 27, 2026; 18(5): 116822
Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.116822

Visceral obesity exacerbates perioperative muscle loss and impairs survival in colorectal cancer

Yun Wang, Jun Bu, Chen-Yang Zhan, Da-Lin Xu, Jia-Qi Hu, Ming-Hao Zhang, Ke-Jin Zhu, Yang Qi

Yun Wang, Jun Bu, Da-Lin Xu, Jia-Qi Hu, Ming-Hao Zhang, Ke-Jin Zhu, Yang Qi, Department of General Surgery, Sichuan University Affiliated Chengdu Second People’s Hospital, Chengdu 610021, Sichuan Province, China

Yun Wang, Da-Lin Xu, Ke-Jin Zhu, School of Clinical Medicine, Chengdu Medical College, Chengdu 610500, Sichuan Province, China

Jun Bu, Department of General Surgery, West China School of Medicine, Sichuan University, Chengdu 610021, Sichuan Province, China

Chen-Yang Zhan, Department of General Surgery, 363 Hospital, Chengdu 610097, Sichuan Province, China

Jia-Qi Hu, Ming-Hao Zhang, Yang Qi, School of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China

Author contributions: Wang Y contributed to study conception, drafting and revision; Wang Y and Bu J contributed to data revision; Wang Y, Bu J, Zhan CY, Xu DL, Hu JQ, Zhang MH, Zhu KJ, and Qi Y contributed to data interpretation; Wang Y, Zhan CY, Xu DL, Hu JQ, Zhang MH, Zhu KJ, and Qi Y contributed to data acquisition and data analysis. All authors reviewed and approved the final manuscript.

AI contribution statement: We used DeepSeek during the final revision stage, but it was used only for language polishing, i.e., refining grammar, word choice, and sentence structure to enhance readability. It was not used for translation, data analysis, or any form of scientific content generation.

Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Chengdu Second People’s Hospital, Approval No. [KY]PJ2024015.

Informed consent statement: Due to the retrospective, observational nature of this study, which utilized anonymized data extracted from routine clinical records, the requirement for obtaining written informed consent from individual participants was waived by the Ethics Committee of Chengdu Second People’s Hospital. All patient data were de-identified prior to analysis to safeguard privacy.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Data are not publicly available to protect patient privacy; however, they can be obtained from the corresponding author upon reasonable request.

Corresponding author: Jun Bu, MD, PhD, Chief Physician, Department of General Surgery, Sichuan University Affiliated Chengdu Second People’s Hospital, No. 10 Qingyun South Street, Jinjiang District, Chengdu 610021, Sichuan Province, China. bj_227688@126.com

Received: November 21, 2025
Revised: December 23, 2025
Accepted: February 10, 2026
Published online: May 27, 2026
Processing time: 188 Days and 0.1 Hours

Abstract

BACKGROUND

Visceral adiposity is implicated in colorectal cancer (CRC) progression and metabolic dysregulation. However, the dynamic interplay between visceral fat area (VFA), perioperative skeletal muscle loss (SML), and long-term survival remains poorly defined. This study aimed to elucidate the impact of VFA on SML and its prognostic value in CRC patients.

AIM

To investigate the impact of VFA on perioperative SML and its prognostic value in CRC patients.

METHODS

A retrospective cohort of 389 CRC patients undergoing radical surgery was analyzed. VFA and skeletal muscle index (SMI) at the L3 level were quantified via preoperative and postoperative computed tomography scans. Multivariate logistic regression identified risk factors for SML, while Cox proportional hazards models evaluated associations with overall survival and relapse-free survival.

RESULTS

High VFA (≥ 100 cm²) was an independent risk factor for SML [odds ratio (OR) = 2.557, 95% confidence interval (CI): 1.518-4.305, P < 0.001] and independently predicted shorter overall survival (hazard ratio = 1.492, 95%CI: 1.069-2.208, P = 0.019) and relapse-free survival (hazard ratio = 1.638, 95%CI: 1.198-2.240, P = 0.002). Elevated preoperative SMI paradoxically increased SML susceptibility (OR = 1.082, P < 0.001), whereas higher body mass index reduced risk (OR = 0.846, P = 0.003). The high-VFA group exhibited greater intraoperative blood loss (median 100 mL vs 80 mL, P = 0.001) and prolonged hospitalization (median 16 days vs 14 days, P = 0.001). Kaplan-Meier analysis confirmed worse survival outcomes in patients with high VFA or SML.

CONCLUSION

Visceral obesity exacerbates perioperative muscle wasting and worsens long-term prognosis in CRC patients. Dynamic computed tomography monitoring of VFA and SMI trajectories offers actionable insights for personalized metabolic interventions, particularly in sarcopenic obesity.

Keywords: Colorectal cancer; Visceral fat; Skeletal muscle loss; Sarcopenic obesity; Prognosis

Core Tip: This study identifies high visceral fat area as an independent driver of perioperative skeletal muscle loss and poor survival in colorectal cancer. Using dynamic computed tomography monitoring, we demonstrate that visceral obesity exacerbates muscle wasting through chronic inflammation. Paradoxically, higher preoperative muscle mass increased skeletal muscle loss risk, potentially indicating underlying myosteatosis. These findings redefine the fat-muscle axis in cancer prognosis and highlight the critical need for preoperative body composition assessment to guide metabolic interventions and improve long-term outcomes.