Excess visceral fat accumulation is a risk factor for postoperative systemic inflammatory response syndrome in patients with esophageal cancer

Background  Although visceral fat accumulation influences various body systems, its significance as a preoperative risk factor is unknown. This study analyzed the relationship between visceral fat accumulation and postoperative morbidity. Methods  The study group consisted of 64 male patients with body mass index (BMI) of 18.5 or more who underwent esophagectomy for esophageal cancer. Clinicopathological, surgical, and postoperative data were collected from medical records. Visceral fat area (VFA) was calculated at the navel level of preoperative CT scan by FatScan ver. 3.0. Results  Based on visceral fat area, patients were divided into high-VFA group (VFA ≥ 100 cm², n = 30) and low-VFA group (VFA < 100 cm², n = 34). Postoperative maximal CRP level was higher in the high-VFA group (23.4 ± 5.7 mg/dl) than the low-VFA group (18.5 ± 7.1 mg/dl, P = 0.004). The duration of systemic inflammatory response syndrome (SIRS) was significantly longer in high-VFA group (3.1 ± 3.4 days) than low-VFA group (1.7 ± 1.9 days, P = 0.048). There were no significant differences in postoperative complications. Differences in CRP and SIRS duration were not evident when the population was divided according to BMI. Visceral fat area (P = 0.001), blood loss (P = 0.029), and field of lymphadenectomy (P = 0.005) correlated with longer duration of SIRS postoperatively (>3 days). Multivariate analysis identified visceral fat area as the only significant determinant of longer duration of SIRS (P = 0.034; HR, 0.984). Conclusions  Patients with visceral fat area of more than 100 cm² are at high risk for prolonged postoperative SIRS.