Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1250-1259
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1250
Comprehensive abdominal composition evaluation of rectal cancer patients with anastomotic leakage compared with body mass index-matched controls
Sheng-Li Shao, Yang-Kun Li, Ji-Chao Qin, Lu Liu
Sheng-Li Shao, Yang-Kun Li, Ji-Chao Qin, Lu Liu, Department of Surgery, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Liu L and Shao SL contributed to conceptualization and design of the study; Shao SL and Li YK contributed to acquisition of the data; Li YK, Shao SL, and Qin JC contributed to methodology; Liu L, Li YK, and Shao SL contributed to formal analysis; Liu L contributed to software; Qin JC contributed to supervision; Shao SL and Liu L contributed to manuscript writing, review, and editing; all authors contributed to final approval of the version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Local Ethical Committee of Tongji Hospital of Huazhong University of Science and Technology (Approval No. TJ-IRB20210719).
Informed consent statement: The patients’ consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: Data used in this study is available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lu Liu, MD, Associate Chief Physician, Department of Surgery, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China.
Received: August 2, 2022
Peer-review started: August 2, 2022
First decision: September 4, 2022
Revised: September 27, 2022
Accepted: November 4, 2022
Article in press: November 4, 2022
Published online: November 27, 2022

Anastomotic leakage (AL) is a fatal complication in patients with rectal cancer after undergoing anterior resection. However, the role of abdominal composition in the development of AL has not been studied.


To investigate the relationship between abdominal composition and AL in rectal cancer patients after undergoing anterior resection.


A retrospective case-matched cohort study was conducted. Complete data for 78 patients with AL were acquired and this cohort was defined as the AL group. The controls were matched for the same sex and body mass index (± 1 kg/m2). Parameters related to abdominal composition including visceral fat area (VFA), subcutaneous fat area (SFA), subcutaneous fat thickness (SFT), skeletal muscle area (SMA), skeletal muscle index (SMI), abdominal circumference (AC), anterior to posterior diameter of abdominal cavity (APD), and transverse diameter of abdominal cavity (TD) were evaluated based on computed tomography (CT) images using the following Hounsfield Unit (HU) thresholds: SFA: -190 to -30, SMA: -29 to 150, and VFA: -150 to -20. The significance of abdominal composition-related parameters was quantified using feature importance analysis; an artificial intelligence method was used to evaluate the contribution of each included variable.


Two thousand two hundred and thirty-eight rectal cancer patients who underwent anterior resection from 2010 to 2020 in a large academic hospital were investigated. Finally, 156 cases were enrolled in the study. Patients in the AL group showed longer operative time (225.03 ± 55.29 vs 207.17 ± 40.80, P = 0.023), lower levels of preoperative hemoglobin (123.32 ± 21.17 vs 132.60 ±1 6.31, P = 0.003) and albumin (38.34 ± 4.01 vs 40.52 ± 3.97, P = 0.001), larger tumor size (4.07 ± 1.36 vs 2.76 ± 1.28, P < 0.001), and later cancer stage (P < 0.001) compared to the controls. Patients who developed AL exhibited a larger VFA (125.68 ± 73.59 vs 97.03 ± 57.66, P = 0.008) and a smaller APD (77.30 ± 23.23 vs 92.09 ± 26.40, P < 0.001) and TD (22.90 ± 2.23 vs 24.21 ± 2.90, P = 0.002) compared to their matched controls. Feature importance analysis revealed that TD, APD, and VFA were the three most important abdominal composition-related features.


AL patients have a higher visceral fat content and a narrower abdominal structure compared to matched controls.

Keywords: Anastomotic leakage, Abdominal composition, Rectal cancer, Body mass index-matched, Anterior to posterior diameter, Transverse diameter

Core Tip: We investigated the association between abdominal composition and anastomotic leakage in rectal cancer patients who underwent anterior resection in a large academic hospital from 2010 to 2020. The data revealed that patients who developed anastomotic leakage had a higher visceral fat content and a narrower abdominal structure, despite body mass index matching.