High pelvic visceral adipose tissue was associated with a reduced risk for overall surgical complications (OR 0.915, p=0.012) and anastomotic leakage (OR 0.587, 95% CI 0.369-0.934, p=0.024).
Observational (n=296)
Does CT-quantified adipose tissue distribution impact medical and surgical complications in rectal cancer patients undergoing surgery?
CT-quantified adipose tissue distribution reveals a complex obesity paradox in rectal cancer surgery, where high pelvic visceral fat protects against anastomotic leakage but increases risk for other complications.
Effect estimate: OR 0.587 (95% CI 0.369-0.934)
p-value: p=0.024
Purpose: Obesity is associated with increased incidence and mortality in rectal cancer (RC). However, an obesity paradox in the sense of a protective effect of obesity is discussed controversially. We evaluated whether adipose tissue distribution has an impact on medical (MC) and surgical complications (SC) after RC surgery. Methods: A total of 296 RC patients underwent oncological surgery and multidetector CT with quantification of total (TAT), visceral (VAT), and subcutaneous adipose tissue (SAT). Logistic regressions on SC (anastomotic leakage n = 26, wound infection n = 58, bleeding n = 12, abscess n = 32, bladder dysfunction n = 24, burst abdomen n = 10), and MC (pulmonary n = 22, cardiac n = 18, urinary tract infection n = 9, sepsis n = 5) were performed. Results: High pelvicVAT was associated with reduced risk for overall SC (OR = 0.915, p = 0.012) and anastomotic leakage (OR = 0.587, p = 0.024, CI: 0.369/0.934). In contrast, CT-quantified obesity was associated with increased risk for wound infection, bladder dysfunction, burst abdomen, overall MC, and cardiac complications (ORs up to 1.423). BMI was not associated with any SC or MC. Conclusion: An obesity paradox with a protective effect of CT-quantified adipose tissue was confirmed for anastomotic leakage and overall SC. In contrast, high adipose tissue was associated with higher risk for other SC and MC. These results show a more complex influence of body composition on MC and SC. CT-quantified obesity is able to provide deeper insights to explain the obesity paradox beyond BMI.
Nattenmüller et al. (Tue,) conducted a observational in Rectal cancer (n=296). High pelvic visceral adipose tissue (VAT) was evaluated on Anastomotic leakage (OR 0.587, 95% CI 0.369-0.934, p=0.024). High pelvic visceral adipose tissue was associated with a reduced risk for overall surgical complications (OR 0.915, p=0.012) and anastomotic leakage (OR 0.587, 95% CI 0.369-0.934, p=0.024).