Published online Apr 26, 2023. doi: 10.12998/wjcc.v11.i12.2766
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
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.
Research on the state of obese patients converting excess heat into excess fat, which can accumulate in the body and cause damage to multiple organs of the circulatory, endocrine, and digestive systems. Abdominal fat accumulation and mesenteric fat in obese patients make laparoscopic surgery difficult, detrimental to surgery, and affecting patient prognosis.
To explore the relationship between body mass index (BMI) and short-term prognosis after surgery for colorectal cancer.
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.
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.
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.
Colorectal rectal cancer (CRC) is a common malignant tumor and ranks third in the incidence of malignant tumors worldwide; it is second only to lung and breast cancers, with a mortality rate of approximately 8% of all malignant tumors. Similar to other malignancies, the cause of CRC remains unclear and can occur anywhere in the colon or rectum; however, it is most common in the rectum and sigmoid colon, whereas the remainder is found sequentially in the cecum, ascending, descending, and transverse colon. Surgical treatment still remains the radical treatment of CRC, and radical resection of intestinal cancer is defined as the removal of macroscopic tumors, including primary and draining lymph nodes. Although the lesion can be removed during surgery, complete removal is still difficult in patients with extensive local disease. For patients with advanced CRC, the tumor size is relatively large, with high vascular variation, and the visual field of laparotomy is poor, making the surgery difficult. In recent years, laparoscopy has emerged as an auxiliary operation with the advantages of a small surgical wound, an open operation field, and rapid postoperative recovery. It has been gradually applied to radical resection of CRC and has achieved an ideal clinical effect.