Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1250
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
Compelling evidence demonstrates the relationship of abdominal composition and postoperative complications. Anastomotic leakage (AL) is a fatal complication in patients with rectal cancer who have received anterior resection. However, the roles of abdominal composition on AL have not been studied.
To study the characteristics of abdominal components in patients who received rectal cancer surgery and developed AL.
To add risk factors for AL prediction in rectal cancer patients undergoing anterior resection for guiding surgical decision-making, e.g., performing a temporary ileostomy or not.
A retrospective case-matched cohort study was conducted. The abdominal composition was quantified based on computed tomography images by setting Hounsfield Unit thresholds. The abdominal composition related parameters were compared and the importance of these indicators was quantified using feature importance analysis.
A total of 156 cases were included in this study. Comparing the abdominal composition related parameters demonstrated that patients who developed AL exhibited a larger visceral fat area (VFA, 125.68 ± 73.59 vs 97.03 ± 57.66, P = 0.008) and a smaller anterior to posterior diameter of abdominal cavity (APD, 77.30 ± 23.23 vs 92.09 ± 26.40, P < 0.001) and transverse diameter of abdominal cavity (TD, 22.90 ± 2.23 vs 24.21 ± 2.90, P = 0.002). Feature importance analysis revealed TD, APD, and VFA to be the three most important abdominal composition related parameters.
Rectal cancer patients who have a higher visceral fat content and a narrower abdominal structure might be at a higher risk of developing AL.
A narrow abdominal structure is associated with the increased difficulty of the operation and prolonged operation time. In addition, the association of abdominal composition related parameters and postoperative complications was reported. But, whether abdominal composition is associated with AL is not known.