Meta-analysis of the clinicopathological characteristics and peri-operative outcomes of colorectal cancer in obese patients |
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| Institution: | 1. Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland;2. Royal College of Surgeons in Ireland, Dublin 2, Ireland;1. Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea;2. Department of Internal Medicine, Nasaret International Hospital, Incheon, Republic of Korea;3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;4. College of Medicine, Chung-Ang University, Seoul, Republic of Korea;5. Department of Pediatrics, Asan Medical Center, Children’s Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Biomedical Research Foundation, House # 7, Apartment # 1A, Road # 1/B, Chairman Bari, Banani, Dhaka 1213, Bangladesh;2. Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh;3. School of Environmental Science and Management, Independent University, Bangladesh;1. Department of Family Medicine and Community Health, JABSOM – University of Hawaii at Manoa, 677 Ala Moana Blvd, Suite 815, Honolulu, HI 96813, United States;2. Yap State Department of Health Services, P.O. Box 1010, Colonia, Yap 96943, Federated States of Micronesia;1. Collaboration for Cancer Outcomes, Research and Evaluation, The Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia;2. Applied Radiation Biology and Radiotherapy Section, Division of Human Health e Department of Nuclear Sciences and Applications, International Atomic Energy Agency, PO Box 100, 1400 Vienna, Austria;1. Faculty of Health Sciences of the University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal;2. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden;3. Department of Statistics, Örebro University, 701 82, Örebro, Sweden;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE 171 77, Stockholm, Sweden;5. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, SE 171 76 Stockholm, Sweden;6. Department of Epidemiology and Public Health, University College, WC1E 6BT London, UK;1. Service de Gynécologie-Obstétrique Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W.I. Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France;2. Institut National de la Santé et de la Recherche Médicale Inserm U1085–IRSET, Campus Universitaire de Fouillole, Pointe à Pitre 97157, Guadeloupe, France;3. Service d’Anatomopathologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W. I. Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France;4. Registre Général des Cancers de Guadeloupe, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe F.W. I. Route de Chauvel, 97159 Pointe-à-Pitre Cedex, France |
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| Abstract: | BackgroundThe effect of obesity on the clinicopathological characteristics of colorectal cancer (CRC) has not been clearly characterized. This meta-analysis assesses the pathological and perioperative outcomes of obese patients undergoing surgical resection for CRC.MethodsMeta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies reporting outcomes for obese and non-obese patients undergoing primary CRC resection, based on body-mass index measurement. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).ResultsA total of 2183 citations were reviewed; 29 studies comprising 56,293 patients were ultimately included in the analysis, with an obesity rate of 19.3%. Obese patients with colorectal cancer were more often female (OR 1.2, 95% CI 1.1–1.2, p < 0.001) but there was no difference in the proportion of rectal cancers, T4 tumours, tumour differentiation or margin positivity. Obese patients were significantly more likely to have lymph node metastases (OR 1.2, 95% CI 1.1–1.2, p < 0.001), have a lower nodal yield, were associated with a longer duration of surgery, more blood loss and conversions to open surgery (OR 2.6, 95% CI 1.6–4.0, p < 0.001) but with no difference in length of stay or post-operative mortality.ConclusionThis meta-analysis demonstrates that obese patients undergoing resection for CRC are more likely to have node positive disease, longer surgery and higher failure rates of minimally invasive approaches. The challenges of colorectal cancer resection in obese patients are emphasized. |
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| Keywords: | Obesity Body-mass index Stage Colorectal cancer Lymph node yield Anastomotic leak |
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