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
Research background

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.

Research motivation

To study the characteristics of abdominal components in patients who received rectal cancer surgery and developed AL.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

Rectal cancer patients who have a higher visceral fat content and a narrower abdominal structure might be at a higher risk of developing AL.

Research perspectives

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.