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J Surg Oncol. 2018 Mar;117(3):523-528. doi: 10.1002/jso.24876. Epub 2017 Nov 9.

The impact of visceral adipose tissue amount on the adequacy of lymph node retrieval in colorectal cancer surgery.

Author information

1
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
2
Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
3
Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
4
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
5
Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.

Abstract

BACKGROUND:

Obesity is increasing worldwide, potentially influencing surgical outcomes in colorectal cancer (CRC) patients. We analyzed the effects of obesity indexes on lymph node (LN) retrieval in CRC patients.

METHOD:

We applied obesity indexes of body mass index (BMI) and visceral (VAT) and subcutaneous (SAT) adipose tissue volumes to stage I-III CRC patients. The primary outcome was the effect of these indexes on the number of retrieved LNs (12 > LNs ≥ 12).

RESULTS:

Among 519 patients, 35.6% had a BMI ≥ 25 kg/m2 . After adjusting for gender, age, tumor location, resected colon length, and local invasion and LN statuses, patients in the highest VAT quartile showed a 5.848 decrease in the number of retrieved LNs, with an odds ratio of 0.483 (95% confidence interval [CI] 0.260-0.8979) for adequate LN retrieval (≥12), compared with those in the lowest quartile (P < 0.001 for both). Analysis of the model predicting LN retrieval revealed VAT as the only obesity index (area under the curve [AUC] = 0.721) providing significant additional predictive power (P = 0.037) to the model including age, gender, staging, tumor location, and resected colon length (AUC = 0.707).

CONCLUSION:

Increased VAT may cause inadequate LN retrieval in CRC patients. In viscerally obese patients, VAT volumes should be considered when clinically interpreting LN status.

KEYWORDS:

adipose tissue; colorectal cancer; lymph node; obesity

PMID:
29121405
DOI:
10.1002/jso.24876
[Indexed for MEDLINE]

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