Impact of obesity on short-term results of laparoscopic rectal cancer resection
Impact of obesity on short-term results of laparoscopic rectal cancer resection
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DOI：
10.1007/s00464-008-0266-5
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发表时间：
2009-07-01
影响因子：
3.1
通讯作者：
Delpero, Jean-Robert
中科院分区：
文献类型：
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作者：
Bege, Thierry;Lelong, Bernard;Delpero, Jean-Robert
前言肥胖[体重指数(BMI)=30 kg/m(2)]对腹腔镜结直肠手术结果的影响仍然存在争议。由于腹腔镜直肠切除术的复杂性，需要具体评估肥胖对手术可行性和短期效果的影响。方法2002年2月至2007年5月，共施行了210例直肠系膜切除术。人口学、肿瘤学和围手术期数据被输入一个预期的数据库。体重指数>30 kg/m(2例)的24例患者(11.4%)为肥胖组(OG)。结果肥胖组美国麻醉学家协会(ASA)评分为3分的患者明显多于非肥胖组(26%和9%，P=0.03)。肥胖患者的手术时间更长(OG组为513min，NOG组为421min)，中转开腹频率更高(OG组为46%，NOG组为12%)。肥胖组发病率1级高于非肥胖组(29.2%比9.7%；p=0.01)，但2级或更高的发病率差异无统计学意义(33.3%比32.3%)。此外，肥胖者中转开腹并没有显著增加2级或更高的发病率(OG中转开腹5例，非OG中转开腹13例；p=0.39)。肿瘤学参数(如淋巴结清除量、远端切缘和侧缘)在两组间无差异。结论肥胖增加了直肠肿瘤腹腔镜直肠切除术的手术时间和中转率。虽然肥胖与较差的术前评估有关，但相关发病率没有增加，肿瘤安全性也没有受到损害。
Introduction The influence of obesity [body mass index (BMI) >= 30 kg/m(2)] on the outcome of laparoscopic colorectal surgery remains controversial. The complexity of rectal laparoscopic resections requires a specific assessment of the impact of obesity on the feasibility and short-term results of the surgery.Methods Between February 2002 and May 2007, 210 laparoscopic mesorectal excisions were performed. Demographic, oncologic and perioperative data were entered in a prospective database. Twenty-four patients (11.4%) with BMI over 30 kg/m(2) formed the obese group (OG). The outcomes in the OG and the nonobese group (NOG) were compared.Results There were significantly more American Society of Anesthesiologists (ASA) score 3 patients (26% in OG versus 9% in NOG; p = 0.03) in the obese group. Obese patients experienced longer operative times (513 min in OG vs. 421 min in NOG; p < 0.01) and more frequent conversion to laparotomy (46% in OG vs. 12% in NOG; p < 0.001). Morbidity grade 1 was higher in the obese group (29.2% vs. 9.7% in NOG; p = 0.01), but there was no difference in regards to morbidity grade 2 or more (33.3% in OG vs. 32.3% in NOG). In addition, conversion to laparotomy among the obese did not increase significantly morbidity grade 2 or higher (5 of 11 for OG converted vs. 3 of 13 for OG nonconverted; p = 0.39). Regarding the oncological parameters (e. g. number of lymph nodes removed, distal and lateral margins) there was no difference between groups.Conclusion Obesity increases operative duration and conversion rate of rectal laparoscopic resection for cancer. Although obesity is associated with a worse preoperative evaluation, there is no increase in relevant morbidity and no impairment of oncological safety.