Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2023; 11(12): 2766-2779
Published online Apr 26, 2023. doi: 10.12998/wjcc.v11.i12.2766
Relationship between body mass index and short-term postoperative prognosis in patients undergoing colorectal cancer surgery
Ying Li, Ji-Jun Deng, Jun Jiang
Ying Li, Jun Jiang, Department of Thyroid Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Ji-Jun Deng, Department of Ultrasound Imaging, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Author contributions: Li Y conceptualized and designed the study, and collected and compiled the data; Jiang J provided administrative support; Li Y provided the research materials and patients; Deng JJ and Jun Jiang analyzed and interpreted the data; and all authors wrote and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: We have read the PRISMA 2009 checklist and the manuscript has been prepared and revised based on the PRISMA 2009 checklist.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Jiang, MD, Chief Doctor, Department of Thyroid Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou 646000, Sichuan Province, China. jiangjun2023@yeah.net
Received: March 2, 2023
Peer-review started: March 2, 2023
First decision: March 14, 2023
Revised: March 18, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 26, 2023
Processing time: 54 Days and 15.4 Hours
Abstract
BACKGROUND

Obesity is a state in which excess heat is converted into excess fat, which accumulates in the body and may cause damage to multiple organs of the circulatory, endocrine, and digestive systems. Studies have shown that the accumulation of abdominal fat and mesenteric fat hypertrophy in patients with obesity makes laparoscopic surgery highly difficult, which is not conducive to operation and affects patient prognosis. However, there is still controversy regarding these conclusions.

AIM

To explore the relationship between body mass index (BMI) and short-term prognosis after surgery for colorectal cancer.

METHODS

PubMed, Embase, Ovid, Web of Science, CNKI, and China Biology Medicine Disc databases were searched to obtain relevant articles on this topic. After the articles were screened according to the inclusion and exclusion criteria and the risk of literature bias was assessed using the Newcastle-Ottawa Scale, the prognostic indicators were combined and analyzed.

RESULTS

A total of 16 articles were included for quantitative analysis, and 15588 patients undergoing colorectal cancer surgery were included in the study, including 3775 patients with obesity and 11813 patients without obesity. Among them, 12 articles used BMI ≥ 30 kg/m2 and 4 articles used BMI ≥ 25 kg/m2 for the definition of obesity. Four patients underwent robotic colorectal surgery, whereas 12 underwent conventional laparoscopic colorectal resection. The quality of the literature was good. Meta-combined analysis showed that the overall complication rate of patients with obesity after surgery was higher than that of patients without obesity [OR = 1.35, 95%CI: 1.23-1.48, Z = 6.25, P < 0.0001]. The incidence of anastomotic leak after surgery in patients with obesity was not significantly different from that in patients without obesity [OR = 0.99, 95%CI: 0.70-1.41), Z = -0.06, P = 0.956]. The incidence of surgical site infection (SSI) after surgery in patients with obesity was higher than that in patients without obesity [OR = 1.43, 95%CI: 1.16-1.78, Z = 3.31, P < 0.001]. The incidence of reoperation in patients with obesity after surgery was higher than that in patients without obesity; however, the difference was not statistically significant [OR = 1.15, 95%CI: 0.92-1.45, Z = 1.23, P = 0.23]; Patients with obesity had lower mortality after surgery than patients without obesity; however, the difference was not statistically significant [OR = 0.61, 95%CI: 0.35-1.06, Z = -1.75, P = 0.08]. Subgroup analysis revealed that the geographical location of the institute was one of the sources of heterogeneity. Robot-assisted surgery was not significantly different from traditional laparoscopic resection in terms of the incidence of complications.

CONCLUSION

Obesity increases the overall complication and SSI rates of patients undergoing colorectal cancer surgery but has no influence on the incidence of anastomotic leak, reoperation rate, and short-term mortality rate.

Keywords: Coloretal rectum cancer; Body mass index; Short-term prognosis; Cancer surgery

Core Tip: Colorectal rectal cancer (CRC) is a common malignant tumor in gastroenterology, ranking the third in the global incidence rate of malignant tumors, second only to lung cancer and breast cancer, with a mortality rate of about 8% of all malignant tumors. Like other malignant tumors, the etiology of CRC is still unclear. It may occur in the colon or anywhere in the rectum, but it is most common in the rectum and sigmoid colon, and the rest are in the cecum, ascending colon, descending colon and transverse colon in turn. So far, the radical treatment of CRC is still surgical treatment. The definition of radical cancer resection is to remove tumors visible to the naked eye, including primary and drainage lymph nodes. Although lesions can be removed during surgery, complete removal is still not easy for patients with extensive local diseases. For patients with advanced CRC, the tumor size is relatively large, there are many vascular variations, the field of vision of laparotomy is poor, and the operation is difficult.