Obesity was associated with a decreased postoperative recurrence of rectal cancer in a Japanese population

Purpose

Obesity contributes to the technical difficulty of rectal surgery and is considered to be a risk factor for postoperative complications. The impact of obesity on the long-term outcomes of rectal cancer surgery remains unclear.

Methods

A total of 263 consecutive rectal cancer patients who underwent surgery were categorized into two groups according to the body mass index (BMI) based on the Asian BMI classification: non-obese (BMI <25 kg/m²) and obese (BMI ≥25 kg/m²). The postoperative survival and recurrence rates and oncological surgical quality indicators were compared between groups using the univariate and multivariate analyses. The differences in recurrence patterns were assessed by a competing risk regression analysis.

Results

64 (24 %) patients were included in the obese group. The number of retrieved lymph nodes was significantly greater in the non-obese group than in the obese group (22.4 vs. 16.0, P < 0.01). The 5-year disease-free survival (DFS) rates were 86.5 and 68.8 % in the obese and non-obese groups, respectively (P = 0.01). The multivariate analysis demonstrated that obesity significantly decreased the postoperative recurrence rate (P = 0.04). Moreover, the BMI was significantly associated with distant metastasis (P = 0.04).

Conclusions

Obese rectal cancer patients have high DFS rates and a decreased incidence of distant metastases compared to non-obese patients. The BMI may be a key factor for predicting the postoperative prognosis and determination of an appropriate strategy for the treatment of rectal cancer patients.     

Obesity Increases Risk for Pouch-Related Complications Following Restorative Proctocolectomy with Ileal Pouch–Anal anastomosis (IPAA)

Purpose

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis and familial adenomatous polyposis. As obesity is becoming more epidemic in surgical patients, the aim of this study was to investigate if obesity increases complication rates following IPAA.

Methods

This study was conducted as a retrospective review of patients undergoing IPAA between January 1990 and April 2011. Patients were categorized by body mass index (BMI): BMI?<?30 (non-obese) and BMI?≥?30 (obese). Preoperative patient demographics, operative variables, and postoperative complications were recorded through chart review. The primary outcome studied was cumulative complication rate.

Results

A total of 103 non-obese and 75 obese patients were identified who underwent IPAA. Obese patients had an increased rate of overall complications (80 % vs. 64 %, p?=?0.03), primarily accounted for by increased pouch-related complications (61 % vs. 26 %, p?<?0.01). In particular, obese patients had more anastomotic/pouch strictures (27 % vs. 6 %, p?<?0.01), inflammatory pouch complications (17 % vs. 4 %, p?<?0.01) and pouch fistulas (12 % vs. 3 %, p?=?0.03). In a regression model, obesity remained a significant risk factor (odds ratio [OR]?=?2.86, p?=?0.01) for pouch-related complications.

Conclusions

Obesity is associated with an increased risk of overall and pouch-related complications following IPAA. Obese patients should be counseled preoperatively about these risks accordingly.     

Re-examining the BMI Threshold for Bariatric Surgery in the USA

Background

The optimal BMI threshold above which gastric bypass surgery should be offered to obese patients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery.

Methods

A Markov state transition model was designed to implement a decision tree that simulated the lives of obese patients. Life expectancies following RYGB and 2 years of D&E were estimated and compared. Ten thousand patients’ lives were simulated in each weight-loss intervention group in the model. In addition to base case analysis (45 kg/m² BMI pre-intervention), sensitivity analysis of initial BMI at the start of the study was completed. Markov model parameters were extracted from the literature.

Results

The impact of RYGB on survival relative to D&E depended on the patient’s initial BMI. Compared to patients who underwent 2 years of “optimal” diet and exercise (7 % total body weight loss/year), RYGB improved long-term survival for patients above a BMI of 31.3 kg/m².

Conclusions

Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.     

Safety of hepatic resection for hepatocellular carcinoma in obese patients with cirrhosis

Purpose

This study aimed at investigating the safety of hepatic resection for hepatocellular carcinoma (HCC) in obese patients with cirrhosis in Japan.

Methods

We reviewed the clinical records of 202 patients with liver cirrhosis, who underwent hepatic resection for HCC between January, 2001 and August, 2011. The patients were divided into three groups according to their body mass index (BMI): the normal body weight (BMI < 24.9 kg/m²), obese class I (BMI 25.0–29.9 kg/m²), and obese class II (BMI ≥ 30 kg/m²) groups. We compared the patient backgrounds, intraoperative factors, and postoperative complications among the three groups.

Results

The normal body weight, obese class I, and obese class II groups comprised 138 (68.3 %), 55 (27.2 %), and 9 (4.5 %) patients, respectively. The incidence of non-B non-C cirrhosis was higher in the obese class II group (22 %) than in the normal body weight group (14 %, p = 0.034). Intraoperative blood loss tended to be higher in the obese class II patients than in the other two groups. Postoperative complications and mortality did not differ significantly among the three groups. According to multivariate analysis, obesity was not a risk factor for postoperative complications (Clavien–Dindo classification Grade III or higher) or mortality.

Conclusion

Hepatic resection for HCC can be performed safely in obese patients with cirrhosis.     

Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?

Introduction

Obesity affects 36 % of American women and is a well-documented breast cancer risk factor. Preoperative axillary ultrasound (AUS) is used routinely for axillary staging in newly diagnosed breast cancer patients; However, the impact of obesity on the usefulness of AUS is unknown. Our aim was to evaluate the effect of body mass index (BMI) on the performance of AUS.

Methods

From our prospective breast surgery database, we identified 1,510 consecutive invasive breast cancers in patients undergoing primary surgery, including axillary operation, from January 2010 to July 2013. Preoperative AUS was performed in 1,375 cases (91 %). We analyzed patient, pathology and imaging data.

Results

Median BMI was 27.4 and 479 patients (36 %) were classified as obese (BMI ≥ 30). Most tumors were T1 (71 %) and estrogen receptor-positive (87 %). AUS was suspicious in 401 (29 %) patients, of whom 374 had ultrasound-guided lymph node fine-needle aspiration (FNA). Overall, 124 patients (33.2 %) were FNA positive. FNA identified disease preoperatively in 35.8 % of node-positive obese patients. For all BMI categories (normal, overweight, obese), AUS was predictive of pathologic nodal status (p < 0.0001). AUS sensitivity did not differ across BMI categories, while specificity and accuracy were better for overweight (p = 0.001 and 0.008, respectively) and obese (p = 0.007 and 0.02, respectively) patients, than for normal-BMI patients.

Conclusions

Despite theoretical concern regarding both potential technical challenges and obesity-related lymph node alterations, the sensitivity of preoperative AUS for detecting nodal metastasis was similar in obese and non-obese patients, while specificity was better in obese patients. Preoperative AUS is valuable for preoperative nodal staging of obese breast cancer patients.     

An Elevated Body Mass Index Does Not Reduce Survival After Esophagectomy for Cancer

Background

Incidences of esophageal cancer and obesity are both rising in the United States. The aim of this study was to determine the influence of elevated body mass index on outcomes after esophagectomy for cancer.

Methods

Overall and disease-free survivals in obese (BMI ≥ 30), overweight (BMI 25–29), and normal-weight (BMI 20–24) patients undergoing esophagectomy constituted the study end points. Survivals were calculated by the Kaplan–Meier method, and differences were analyzed by log rank method.

Results

The study included 166 obese, 176 overweight, and 148 normal-weight patients. These three groups were similar in terms of demographics and comorbidities, with the exception of younger age (62.5 vs. 66.2 vs. 65.3 years, P = 0.002), and higher incidence of diabetes (23.5 vs. 11.4 vs. 10.1%, P = 0.001) and hiatal hernia (28.3 vs. 14.8 vs. 20.3%, P = 0.01) in obese patients. Rates of adenocarcinoma histology were higher in obese patients (90.8 vs. 90.9 vs. 82.5%, P = 0.03). Despite similar preoperative stage, obese patients were less likely to receive neoadjuvant treatment (47.6 vs. 54.5 vs. 66.2%, P = 0.004). Response to neoadjuvant treatment, type of surgery performed, extent of lymphadenectomy, rate of R0 resections, perioperative complications, and administration of adjuvant chemotherapy were not influenced by BMI. At a median follow-up of 25 months, 5-year overall and disease-free survivals were longer in obese patients (respectively, 48, 41, 34%, P = 0.01 and 48, 44, 34%, P = 0.01).

Conclusions

In our experience, an elevated BMI did not reduce overall and disease-free survivals after esophagectomy for cancer.     

Metabolic abnormalities,but not obesity,contribute to the mildly reduced eGFR in middle-aged and elderly Chinese

Background

The role of obesity as a determinant of kidney dysfunction has not reached an agreement and the underlying reason may be due to the heterogeneity of obese phenotypes. The aim of the study was to explore the associations of different obese phenotypes with the change of estimated glomerular filtration rate (eGFR) and the roles of obesity and metabolic abnormalities in this association.

Methods

eGFR was calculated in 8,586 participants (≥40 years old). eGFR 60–90 mL/min/1.73 m² was defined as the mildly reduced eGFR. Multiple logistic regression analysis was used to determine odds ratios (ORs) for mildly reduced eGFR in the metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO) groups, using the metabolically healthy non-obese (MHNO) subjects as the reference group. Meanwhile, the associations of body mass index (BMI), waist circumference (WC) and metabolic abnormalities (including hypertension, hyperglycemia and dyslipidemia) with the risk of mildly reduced eGFR were also investigated.

Results

The proportion of MHNO, MHO, MANO and MAO subjects was 8.3, 17.1, 10.1 and 64.5 %, respectively. Increased ORs were observed in MANO (OR 1.51, P = 0.014) and MAO (OR 1.47, P = 0.015) groups, after adjusting for age, gender, smoking, drinking, BMI and WC. When further adjusting for metabolic abnormalities, MANO (OR 1.24, P = 0.247) and MAO (OR 1.17, P = 0.366) subjects would not present increased risk of mildly reduced eGFR any more. Oppositely, fasting insulin (OR 1.03, P < 0.001), hyperglycemia (OR 1.25, P = 0.002) and dyslipidemia (OR 1.25, P = 0.002), but not hypertension, BMI and WC, significantly increased the risk of mildly reduced eGFR.

Conclusions

Metabolic abnormalities, but not simple obesity, may contribute to the mildly reduced eGFR in middle-aged and elderly Chinese.     

Differences in lumbar and pelvic parameters among African American,Caucasian and Asian populations

Purpose

Ethnic differences in spino-pelvic parameters among a healthy population are poorly defined in the literature. The purpose of this study was to document sagittal spino-pelvic parameters in a sample of African Americans and to compare them with previously reported data for Caucasians and Asians.

Methods

African American individuals without spine pathology who had standing lateral radiographs were identified. Radiographs were measured to determine the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Data of adult subjects were compared with those previously published for Caucasians (n?=?709) and Asians (n?=?312).

Results

These measurements (LL, PI, PT, and SS) obtained for the 36 African American subjects aged 18 years or older [15 men and 21 women; mean age 26.6?±?8.7 range (18–53)] The mean LL, PI, PT and SS values were 57.2°, 57.7°, 15.9° and 41.4°, respectively. A comparative analysis showed the means values for PI was greater in the African American than in Caucasian (57.7° vs. 52.6°, p?=?0.007), and than in Asian (57.7° vs. 48.7°, p?<?0.001). The linear regression model for the LL as a function of PI were “predict LL?=?0.41?×?PI?+?33.7” in African American, “predict LL?=?0.58?×?PI?+?24.3” in Caucasian, and “predict LL?=?0.54?×?PI?+?22.0” in Asian, respectively.

Conclusion

Significant differences in sagittal spino-pelvic parameters among races were seen. These differences should be considered when planning surgical reconstruction for spinal surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Open image in new window

     

The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases

Purpose

A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results.

Methods

Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients’ symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrum-bicoxofemoral distance (SFD).

Results

The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P < 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P < 0.05).

Conclusions

PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.     

Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry

Summary

Due to missing indications for specific diagnostics, the majority of non-symptomatic vertebral fractures are not diagnosed. This study shows the ability of radiation-free spinometry to assess sagittal spine parameters to raise suspicion for new non-traumatic thoracic and lumbar vertebral fractures and indicate specific diagnostics.

Introduction

The primary aim of this study was to investigate the accuracy of radiation-free spinometry to predict new non-traumatic vertebral fractures (VF) by the assessment of thoracic kyphosis (TK), lumbar lordosis (LL), and trunk inclination.

Methods

Three hundred sixty-one patients (278 females and 83 males; age, 67.0?±?8.6 years) were enrolled. In 86 women and 24 men, at least one non-traumatic VF was confirmed by radiography, MRI, and/or CT. Spinometry (video rasterstereography) was used to assess TK, LL, and trunk inclination. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed to test the influence of age, sex, number, location, and grade of fractures on sagittal spine alignment.

Results

TK, LL, and trunk inclination were associated with advancing age (p?<?0.05). Patients with prevalent thoracic and lumbar VFs showed increased TK (p?<?0.001), decreased LL (p?<?0.001), and increased trunk inclination (p?<?0.001) in comparison to patients without VFs. ROC analysis revealed that the combination of TK and LL presented with the best predictive accuracy to raise suspicion for new grade 2 or grade 3 VFs in the thoracic and the lumbar spine (AUC, 0.752–0.771). Odds ratio (OR) showed an increased risk for VFs with increased TK (OR, 1.05–1.11; p?<?0.001) and LL (1.05–1.07; p?<?0.001) in specified regions of interest. A TK <50° (sensitivity, 88–100 %; specificity, 23–25 %) and LL (78–92 %; 24–27 %) were considered as appropriate cutoffs for future screening.

Conclusion

Spinometry showed better predictive accuracy than historical height loss. Severe changes of TK and LL may help to raise suspicion of new VFs radiation-free and indicate proper diagnostics, such as radiographs, MRI, or CT.     

Single-port cholecystectomy in obese patients: our experience and a review of the literature

Purpose

The objective of the present study was to compare the postoperative outcomes between obese and normal-weight patients undergoing single-port cholecystectomy (SPC) for gallstone disease.

Methods

A prospectively maintained SPC-database was retrospectively analyzed, and the outcomes of obese [body mass index (BMI) ≥30 kg/m²] and normal-weight patients were compared. All patients underwent SPC using the reusable X-Cone? device.

Results

A total of 100 patients underwent SPC between July 2009 and September 2011. Seventeen obese patients (17 %) (median BMI 33.9 kg/m², range 30.0–38.8) were compared to 83 normal-weight patients (median BMI 24.1 kg/m², range 17.3–29.5). The length of the operation (median 75.5 min, range 42–156 vs. median 72.0 min, range 42–129; p = 0.51), conversion rate (N = 2 vs. N = 0; p = 1), postoperative complication rate (9.6 vs. 11.8%; p = 0.68), and postoperative hospital stay (median 3 days, range 1–14 vs. median 3 days, range 2–5; p = 0.74), were comparable for the normal-weight and obese patients.

Conclusion

The postoperative outcome of obese patients after SPC is not inferior to that of normal-weight patients undergoing the same operation. Therefore, the BMI should not be considered a key criterion in the patient selection for single-port surgery.     

Laparoscopic Gastric Bypass vs. Sleeve Gastrectomy in the Super Obese Patient: Early Outcomes of an Observational Study

Background

Super obesity [body mass index (BMI)?>?50 kg/m²] can yield to higher morbidity/mortality in bariatric surgery, this could be related to patient's characteristics and/or surgeon's experience. In morbid obesity, both techniques proved to have a positive impact and sometimes comparable outcomes during the first 2 years. This has not been clearly analyzed in the super obese patient.

Methods

Retrospective study comparing the records of 77 consecutive super obese patients (BMI: 50–59.9 kg/m²) submitted to either laparoscopic gastric bypass (LGBP, n?=?32) or laparoscopic sleeve gastrectomy (LSG, n?=?45) between 2010 and 2012 at a single institution. The primary objective was to analyze baseline demographics, comorbidities, operative outcomes, and early complications (<30 days). Secondarily, weight loss [BMI and % excess weight loss (%EWL)] was also described and compared during the first year.

Results

Female sex comprised 72.7 % of all cases. Both groups had comparable BMI (52.7?±?2.1 kg/m² for LGBP vs. 53.87?±?2.8 kg/m² for LSG; p?=?0.087) and homogeneous baseline characteristics. Operative time was lower for the LSG group (113.1?±?35.3 vs. 186.9?±?39 min for LGBP; p?≤?0.001). Overall, early complications were observed in 16.8 % of patients (LGBP 9 % vs. LSG 22 %; p?=?0.217). There were four major complications (two in each group), with two reinterventions. Weight loss (%EWL) at 6, 9, and 12 months was significantly higher in the LGBP group (51.6?±?12.9 %, 56.5?±?13 %, 63.9?±?13.3 %, respectively) than in the LSG group (40?±?12.8 %, 45.1?±?15.5 %, 43.9?±?10.4 %, respectively).

Conclusions

Just like in morbid obesity, LGBP and LSG are effective and safe procedures in super obese patients. LGBP had better weight loss at 1 year.     

Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over-D1” Lymphadenectomy for Gastric Cancer

Introduction

The purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with “over-D1” dissection for gastric cancer.

Methods

Data on 161 patients undergoing total gastrectomy between 2005 and 2011 were reviewed. Patients were grouped into three categories by BMI: BMI < 25 kg/m² (63 normal-weight patients; 39.1 %), BMI ≥ 25–<30 kg/m² (73 overweight patients; 45.3 %), and BMI ≥ 30 kg/m² (25 obese patients; 15.6 %) and matched for the analysis of perioperative and cancer-related outcomes.

Results

Operative time was longer for obese patients. Medical (mainly pulmonary) and surgical (mainly bleeding and wound infection) complications occurred more frequently in overweight/obese subjects. However, they were mostly managed conservatively (grade I–II in the Clavien-Dindo classification). The overall postoperative mortality was 0.9 %. Multivariate analysis identified the American Society of Anesthesiologists score and splenectomy, but not obesity, as independent risk factors for postoperative complications. The median number of lymph nodes retrieved differed significantly from group to group: obese 21 (IQR 18–26), versus overweight 24, versus normal weight 28 (p = 0.031). No difference was found in lymph node ratio and cancer-related parameters.

Conclusions

Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.     

Visceral Obesity and Colorectal Cancer: Are We Missing the Boat with BMI?

Introduction

Compared to subcutaneous fat, visceral fat is more metabolically active, leading to chronic inflammation and tumorigenesis. The aim of this study is to describe the effect of visceral obesity on colorectal cancer outcomes using computed tomography (CT) imaging to measure visceral fat.

Materials and Methods

We conducted a retrospective chart review of patients who underwent surgical resection for colorectal cancer. Visceral fat volume was measured by preoperative CT scans. Final analysis was performed by stratifying patients based on oncologic stage.

Results

Two hundred nineteen patients met the inclusion criteria, 111 viscerally obese and 108 nonobese. Body mass index (BMI) weakly correlated with visceral fat volume measurements (R ²?=?0.304). Whereas obese patients had no difference in survival when categorizing obesity by BMI, categorizing based on visceral fat volume resulted in significant differences in stage II and stage III patients. In stage II cancer, viscerally obese patients had a nearly threefold decrease in disease-free survival (hazard ratio (HR)?=?2.72; 95 % confidence interval (CI)?=?1.21, 6.10). In stage III cancer, viscerally obese patients had a longer time to recurrence (HR?=?0.39; 95 % CI?=?0.16, 0.99).

Conclusion

This study shows that viscerally obese patients with stage II colorectal cancer are at higher risk for poor outcomes and should be increasingly considered for adjuvant chemotherapy.     

Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center

Background

Laparoscopic colorectal surgery (LCRS) has several advantages over open surgery, but LCRS has been associated with a higher rate of postoperative complications (POCs) among obese patients [body mass index (BMI), ≥30 kg/m²]. The prevalence of obesity in Chile is increasing, up to 25.1 % in 2010, suggesting that a higher percentage of patients undergoing LCRS will be obese. This study compared POC rates between obese and nonobese patients undergoing LCRS.

Methods

This study included case and control patients in a prospectively maintained LCRS database who underwent LCRS between July 2007 and June 2012 at Clinica Las Condes, Santiago, Chile. Obese and nonobese (BMI <30 kg/m²) patients were paired by gender, age, American Society of Anesthesiologists class, preoperative diagnosis, and type of surgery. Intraoperative complications and POCs were documented up to 30 days. The severity of each POC was classified by Clavien–Dindo score.

Results

In this study, 449 patients who underwent LCRS during the study period were identified. The study paired 53 obese patients (mean BMI 33.1 kg/m²) with 53 nonobese patients (mean BMI 25.9 kg/m²). The median age was 55 years in the obese group and 57 years in the nonobese group, and 60 % of the patients in both groups were men. The findings showed POCs in 13 obese (24.5 %) and 15 nonobese (28.3 %) patients (p = 0.66). Stratified by severity of POCs, the two groups were similar (p = 0.62). The two groups did not differ in terms of the median time to the first feeding (1 day each) or the hospital length of stay (4 days each). Similar percentages of patients in the two groups required reoperation (p = 0.4), intensive care unit (ICU) admission (p = 0.77), and readmission to the hospital (p = 0.65) because of POCs.

Conclusion

The frequency of POCs after LCRS was no higher among the obese patients than among the nonobese patients.     

Obesity and Peritoneal Surface Disease: Outcomes after Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Appendiceal and Colon Primary Tumors

Background

It is estimated that 37 % of the U.S. population is obese. It is unknown how obesity influences the operative and survival outcomes of cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) procedures.

Methods

A retrospective analysis of a prospective database of 1,000 procedures was performed. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, comorbidities, morbidity, mortality, and survival were reviewed.

Results

A total of 246 patients with body mass index (BMI) of >30 kg/m² underwent 272 CRS/HIPEC procedures. Ninety-five (38.6 %) were severely obese (BMI > 35 kg/m²). A total of 135 (49.6 %) procedures were performed for appendiceal and 60 (22.1 %) for colon cancer. Median follow-up was 52 months. Both major and minor morbidity were similar for obese and non-obese patients. The 30-day mortality rates for obese and non-obese patients were 1.5 and 2.5 %, respectively. Median intensive care unit and hospital stay were 1 and 9 days, regardless of BMI. The 30-day readmission rate was similar between obese and non-obese patients (24.8 vs. 19.4 %, p = 0.11). Median survival for low-grade appendiceal cancer (LGA) was 76 months for obese patients and 107 months for non-obese patients (p = 0.32). Survival was worse for severely obese patients (median survival 54 months) versus non-obese patients with LGA (p = 0.04). Survival was similar for obese and non-obese patients with peritoneal surface disease (PSD) from colon cancer or high-grade appendiceal cancer.

Conclusions

Obesity does not influence postoperative morbidity or mortality of patients with PSD, regardless of primary tumor. Severe obesity is associated with decreased long-term survival only in patients with LGA primary disease; however, application of CRS/HIPEC still offers meaningful prolongation of life. Obesity should not be considered a contraindication for CRS/HIPEC procedures.     

Impact of Obesity on Postoperative and Long-term Outcomes in a General Surgery Population: A Retrospective Cohort Study

Background

The obesity paradox has been demonstrated postoperatively in several surgical populations, but only a few studies have reported long-term survival. This study evaluates the presence of the obesity paradox in a general surgery population, reporting both postoperative and long-term survival.

Methods

This retrospective study included 10,427 patients scheduled for elective, noncardiac surgery. Patients were classified as underweight (body mass index (BMI) < 18.5 kg/m²); normal weight (BMI 18.5–24.9 kg/m²); overweight (BMI 25.0–29.9 kg/m²); obesity class I (BMI 30.0–34.9 kg/m²); obesity class II (BMI 35.0–39.9 kg/m²); and obesity class III (BMI ≥ 40.0 kg/m²). Study endpoints were 30-day postoperative and long-term mortality, including cause-specific mortality. Multivariable analyses were used to evaluate mortality risks for each BMI category.

Results

Within 30 days after surgery, 353 (3.4 %) patients died. Overweight was the only category associated with postoperative mortality, showing improved survival [odds ratio 0.7; 95 % confidence interval (CI) 0.6–0.9]. During the long-term follow-up 4,884 (47 %) patients died. Underweight patients had the highest mortality risk [hazard ratio (HR) 1.4; 95 % CI 1.2–1.6), particularly due to high cancer-related deaths. In contrast, overweight and obese patients demonstrated improved survival (overweight: HR 0.8, 95 % CI 0.8–0.9; obesity class I: HR 0.7, 95 % CI 0.7–0.8; obesity class II: HR 0.7, 95 % CI 0.6–0.9; obesity class III: HR 0.7, 95 % CI 0.5–1.0), mainly because of a strongly reduced risk of cancer-related death.

Conclusions

In this surgical population the obesity paradox was validated at the long term, mainly because of decreased cancer-related deaths among obese patients.     

The impact of obesity on the predictive accuracy of PSA in men undergoing prostate biopsy

Purpose

Obese men have been reported to have lower serum PSA values relative to normal-weight men in population-based studies, screening cohorts, and in men with prostate cancer (CaP) treated with surgery. There are concerns that PSA may be less accurate in detecting prostate cancer in men with increased body mass index (BMI). We determine whether the diagnostic potential of PSA is negatively influenced by obesity by comparing its operating characteristics across BMI categories among men undergoing prostate biopsy.

Methods

Demographic, clinical, and histopathological data on 917 men who underwent trans-rectal ultrasound-guided prostate needle biopsy from 2002 to 2010 at a University hospital in Italy were used in the study. Men were categorized for BMI as follows: <25 kg/m² (normal weight), 25–29.9 kg/m² (overweight), and ≥30 kg/m² (obese). Receiver operator characteristics (ROC) curves were used to assess PSA accuracy for predicting prostate cancer overall and then stratified according to digital rectal examination (DRE) findings using the area under the ROC curve (AUC).

Results

The obesity rate of the study cohort was 21 %. There was no statistically significant difference in the overall AUCs of PSA for predicting CaP among normal-weight (AUC = 0.56), overweight (AUC = 0.60), and obese men (AUC = 0.60; p = 0.68) in either DRE-positive or negative men.

Conclusions

In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of PSA as a predictor of CaP is not significantly altered by BMI. Obesity does not negatively impact the overall ability of PSA to discriminate between CaP and benign conditions.