Confluence of Preoperative high levels of C-Reactive Protein and Visceral Fat index as Potential Contributor to Postoperative Complications in Colorectal Cancer: a Randomized Clinical Trial Incorporating Parenteral Nutrition

Abstract Background: Visceral fat and inflammatory conditions are risk factors in patients undergoing colorectal cancer (CRC) surgery. This study was conducted to evaluate the effect of early peripheral parenteral nutrition (PPN) in patients with an elevated inflammatory state and/or an increase in their visceral fat on the anastomotic leak of patients undergoing CRC surgery within an enhanced recovery program. Methods: A clinical trial was performed in patients undergoing CRC surgery between October 2016 and September 2019. Patients were randomized into two groups: PPN with periOlimel N4-E and conventional fluid therapy (FT). With C-reactive protein (CRP) values prior to surgery and visceral fat analysis of preoperative computer tomography, patients were stratified according to their risk of anastomotic leakage (AL). AL rates was obtained in each risk group differentiating whether they had received PPN or FT. Results: A total of 116 patients were analyzed; 63 received PPN and 53 FT. Patients with high visceral fat index (VFI) had higher mean postoperative CRP values, especially on the 2nd postoperative day (p<0.05). CRP values prior to surgery ≥5 mg/L and high VFI were associated with an AL rate of 28% (30% FT group vs. 23.5% PPN group): OR (95% CI) of 4.8 (p=0.003), and CRP values ≥10.2 mg/L showed an AL rate of 25.7% (30.8% FT group vs. 22.7% PPN group): OR (95% CI) of 6.6 (p= 0.001). Conclusions: Analysis of visceral fat and the inflammatory state of patients with CRC allows us to evaluate the risk of anastomotic leakage, and PPN should be considered to improve AL rates. Trial registration number: NCT03606863