Visceral Fat and Anastomotic Leakage After Colon Cancer Resection.

BACKGROUND: Visceral fat is considered a risk for postoperative complications in colon cancer surgery. However, the association with anastomotic leakage as the most worrisome complication is not clear mainly because of underpowered studies. OBJECTIVE: The purpose of this study was to analyze the effect of visceral fat as a continuous variable on anastomotic leakage in a large cohort of colon cancer resections. DESIGN: This was a retrospective, multicenter cohort study. SETTINGS: This study used data of the Dutch Surgical Colorectal Audit of the years 2011 through 2014 from 8 Dutch teaching hospitals. Visceral fat was assessed on the routine preoperative abdominal CT scan. PATIENTS: A total of 2370 patients underwent colon cancer resection with primary anastomosis. There were 2011 patients operated electively and 359 in an emergency setting. MAIN OUTCOME MEASURES: The effect of visceral fat on anastomotic leakage after multivariable analysis was measured. RESULTS: Visceral fat was associated with anastomotic leakage in the elective colon resection group (n = 2011) but not in emergency colon resections (n = 359). Significant confounding was found for type of resection, BMI, and sex. The association of male sex and BMI as previously reported risk factors for anastomotic leakage was explained by visceral fat. LIMITATIONS: The study was limited by its retrospective character and missing clinical data of known risk factors for anastomotic leakage, like smoking history and certain medication. CONCLUSIONS: The independent association of visceral fat with anastomotic leakage was confined to the elective colon cancer resection group. The previously reported associations of male sex and BMI with anastomotic leakage were explained by visceral fat. Visceral fat-associated comorbidities did not influence anastomotic leakage, suggesting that its effect on colon anastomotic healing is local rather than systemic. Future risk analysis for anastomotic leakage in colon cancer surgery should contain visceral fat values and consider subgroup differences. See Video Abstract at http://links.lww.com/DCR/B396. ADIPOSIDAD VISCERAL Y FUGA ANASTOMTICA EN CASOS DE RESECCIN DE CNCER DE COLON: ANTECEDENTES:La acumulación de grasa visceral se considera como un factor de riesgo en caso de complicaciones postoperatorias de cirugía de cáncer de colon. Sin embargo, la asociación con la fuga anastomótica como la complicación más preocupante no está clara principalmente debido a los estudios de bajo impacto disponibles.OBJETIVO:Analizar el efecto de la adiposidad visceral como una variable contínua sobre la fuga anastomótica en una gran cohorte de resecciones de cáncer de colon.DISEÑO:Estudio de cohorte multicéntrico retrospectivo.AJUSTES:Se utilizaron los datos de la Auditoría Colorrectal Quirúrgica Holandesa entre los años 2011 y 2014 en 8 hospitales de enseñanza de los Paises bajos. La grasa visceral fué evaluada por medio de la tomografía computada abdominal preoperatoria de rutina.PACIENTES:Un total de 2370 pacientes fueron sometidos a resección de cáncer de colon con anastomosis primaria. 2011 pacientes fueron operados electivamente y 359 en situación de emergencia.PRINCIPALES MEDIDAS DE RESULTADO:El efecto de la adiposidad visceral en la fuga anastomótica después del análisis multivariable.RESULTADOS:La grasa visceral se asoció con la fuga anastomótica en el grupo de resección electiva de colon (n = 2011) pero no en las resecciones de emergencia (n = 359). Se encontraron factores de confusión significativos para el tipo de resección, el índice de masa corporal y el género. La adiposidad visceral explica la asociación del género masculino y el índice de masa corporal como factores de riesgo reportados previamente en los casos de fugas anastomóticas.LIMITACIONES:Carácter retrospectivo del estudio y la falta de datos clínicos de factores de riesgo conocidos para la fuga anastomótica, como los antecedentes de tabaquismo y el consumo de ciertos medicamentos.CONCLUSIONES:La asociación independiente de la adiposidad visceral con la fuga anastomótica se limitó al grupo de resección electiva por cáncer de colon. Las asociaciones previamente reportadas de género masculino e índice de masa corporal con fuga anastomótica se explicaron por la grasa visceral. Las comorbilidades asociadas a la grasa visceral no influyeron en la fuga anastomótica, lo que sugiere que la cicatrisación anastomótica obedece más a un factor local que a un factor sistémico. Un análisis de riesgos previsibles para fugas anastomóticas en casos de resección de cáncer de colon deben involucrar los valores de la adiposidad visceral y considerar las diferencias entre subgrupos. Consulte Video Resumen en http://links.lww.com/DCR/B396. (Traducción-Dr Xavier Delgadillo).

Visceral fat loss by whole-body electromyostimulation is attenuated in male and absent in female older Non-Insulin-Dependent diabetes patients.

INTRODUCTION: Type 2 diabetes and its reversal correlate with increases and decreases in visceral fat (VF). Resistance exercise reduces VF in healthy persons, but little is known in type 2 diabetes. Muscle contractions induced by whole-body electromyostimulation (WB-EMS) provide a very effective form of resistance training. We hypothesized that WB-EMS reduces VF and improves plasma glucose measures in older non-insulin dependent diabetes mellitus (NIDDM) males and females. METHODS: A four-arm age-matched case control study was done on WB-EMS twice a week in older NIDDM patients (27 males, 18 females) compared with controls (15 males, 15 females). VAT area (VAT, cm2 ), total fat mass (TFM, kg) and lean body mass (LBM, kg) were assessed by DEXA-scanning. HbA1c, fasting glucose and plasma lipoproteins were measured at baseline and after 4 months. RESULTS: Baseline control VAT was higher in males than females (140.5 ± 35.6 vs. 96.7 ± 42.3, p < .001). In NIDDM, VAT was higher with no significant sex difference (206.5 ± 65.0 vs. 186.5 ± 60.5). In controls, WBEMS reduced VAT in males and females to similar extent (-16.9% and -16.4%, p < .001 vs. baseline) and in preference to TFM (-9.2% and -3.6%) or body weight loss (-2.8 and -2.1%). In NIDDM, VF loss was attenuated in males (-7.3%, p < .01) but completely absent in females. WBEMS reduced HbA1c and cholesterol and increased HDL levels (all p < .05) only in male NIDDM CONCLUSIONS: WBEMS induced VF loss in healthy older males and females an effect strongly attenuated in male and completely absent in female NIDDM patients. This questions the effectiveness of muscle contraction-induced VF lipolysis in NIDDM. Sex differences may dictate the success of resistance training in NIDDM, a subject that needs to be addressed in future studies.

Visceral obesity, body mass index and risk of complications after colon cancer resection: A retrospective cohort study.

BACKGROUND: The aim of our study was to assess the influence of visceral obesity (VO), as measured by preoperative abdominal CT scan, in relation to body mass index (BMI) on the incidence of postoperative complications and duration of hospital stay after colon cancer surgery. METHODS: Patients who underwent elective resection for colon cancer between January 1, 2006, and December 31, 2013, and had a preoperative CT scan were entered in the study. Visceral fat area (VFA) was determined by using the preoperative CT scan at the L3-L4 level. The effect of VO, defined as a VFA of >100 cm², on postoperative complications and duration of hospital stay was analyzed. RESULTS: Of 564 included patients, 65% had VO. VO was associated with more anastomotic leakage (P = .04), pneumonia (P = .02), wound infection (P = .03), reoperations (P = .04), and longer duration of hospital stay (P = .05). Of patients with a BMI < 25 kg/m², 44% had VO. In this group, VO was associated significantly with postoperative complications, cardiac (P < .01) and pulmonary (P = .01) comorbidity, hypertension (P < .01), and diabetes (P < .01). In the overweight (BMI 25-30 kg/m²) and obese (BMI > 30 kg/m²) groups, the rate of VO was much higher (81% and 90%, respectively), but was not associated significantly with complications or comorbidity, except for cardiac comorbidity (P < .02) in the BMI = 25-30 kg/m² group. After multivariable analysis, VO was shown to be an independent predictor of anastomotic leakage and wound infection. CONCLUSION: The association of VO with worse outcome after colon cancer surgery is most pronounced in patients with a BMI < 25 kg/m².