Visceral Fat and Anastomotic Leakage After Colon Cancer Resection

Background Visceral fat is considered a risk for postoperative complications in colon cancer surgery. However, the association with anastomotic leakage as the most worrisome complication is not clear mainly because of underpowered studies. Objective The purpose of this study was to analyze the effect of visceral fat as a continuous variable on anastomotic leakage in a large cohort of colon cancer resections. Design This was a retrospective, multicenter cohort study. Settings This study used data of the Dutch Surgical Colorectal Audit of the years 2011 through 2014 from 8 Dutch teaching hospitals. Visceral fat was assessed on the routine preoperative abdominal CT scan. Patients A total of 2370 patients underwent colon cancer resection with primary anastomosis. There were 2011 patients operated electively and 359 in an emergency setting. Main outcome measures The effect of visceral fat on anastomotic leakage after multivariable analysis was measured. Results Visceral fat was associated with anastomotic leakage in the elective colon resection group (n = 2011) but not in emergency colon resections (n = 359). Significant confounding was found for type of resection, BMI, and sex. The association of male sex and BMI as previously reported risk factors for anastomotic leakage was explained by visceral fat. Limitations The study was limited by its retrospective character and missing clinical data of known risk factors for anastomotic leakage, like smoking history and certain medication. Conclusions The independent association of visceral fat with anastomotic leakage was confined to the elective colon cancer resection group. The previously reported associations of male sex and BMI with anastomotic leakage were explained by visceral fat. Visceral fat-associated comorbidities did not influence anastomotic leakage, suggesting that its effect on colon anastomotic healing is local rather than systemic. Future risk analysis for anastomotic leakage in colon cancer surgery should contain visceral fat values and consider subgroup differences. See Video Abstract at http://links.lww.com/DCR/B396. Adiposidad visceral y fuga anastomtica en casos de reseccin de cncer de colon ANTECEDENTES:La acumulacion de grasa visceral se considera como un factor de riesgo en caso de complicaciones postoperatorias de cirugia de cancer de colon. Sin embargo, la asociacion con la fuga anastomotica como la complicacion mas preocupante no esta clara principalmente debido a los estudios de bajo impacto disponibles.OBJETIVO:Analizar el efecto de la adiposidad visceral como una variable continua sobre la fuga anastomotica en una gran cohorte de resecciones de cancer de colon.DISENO:Estudio de cohorte multicentrico retrospectivo.AJUSTES:Se utilizaron los datos de la Auditoria Colorrectal Quirurgica Holandesa entre los anos 2011 y 2014 en 8 hospitales de ensenanza de los Paises bajos. La grasa visceral fue evaluada por medio de la tomografia computada abdominal preoperatoria de rutina.PACIENTES:Un total de 2370 pacientes fueron sometidos a reseccion de cancer de colon con anastomosis primaria. 2011 pacientes fueron operados electivamente y 359 en situacion de emergencia.PRINCIPALES MEDIDAS DE RESULTADO:El efecto de la adiposidad visceral en la fuga anastomotica despues del analisis multivariable.RESULTADOS:La grasa visceral se asocio con la fuga anastomotica en el grupo de reseccion electiva de colon (n = 2011) pero no en las resecciones de emergencia (n = 359). Se encontraron factores de confusion significativos para el tipo de reseccion, el indice de masa corporal y el genero. La adiposidad visceral explica la asociacion del genero masculino y el indice de masa corporal como factores de riesgo reportados previamente en los casos de fugas anastomoticas.LIMITACIONES:Caracter retrospectivo del estudio y la falta de datos clinicos de factores de riesgo conocidos para la fuga anastomotica, como los antecedentes de tabaquismo y el consumo de ciertos medicamentos.CONCLUSIONES:La asociacion independiente de la adiposidad visceral con la fuga anastomotica se limito al grupo de reseccion electiva por cancer de colon. Las asociaciones previamente reportadas de genero masculino e indice de masa corporal con fuga anastomotica se explicaron por la grasa visceral. Las comorbilidades asociadas a la grasa visceral no influyeron en la fuga anastomotica, lo que sugiere que la cicatrisacion anastomotica obedece mas a un factor local que a un factor sistemico. Un analisis de riesgos previsibles para fugas anastomoticas en casos de reseccion de cancer de colon deben involucrar los valores de la adiposidad visceral y considerar las diferencias entre subgrupos. Consulte Video Resumen en http://links.lww.com/DCR/B396. (Traduccion-Dr Xavier Delgadillo).