Introduction: Obesity has reached epidemic proportions in developed countries. Colorectal cancers is also in those countries, the second most frequent diagnosed cancer. There are no definitive data in medical literature, regarding the impact that overweight have in the outcomes, of colorectal cancer treatment. Goals: To asses the influence of obesity and preobesity in postoperative and intraoperative morbidity and mortality, long term survival, tumour characteristics and clinical parameters, as well as identify prognostic factors for patients submitted to elective colorectal cancer surgery. Patients and methods: Inclusion criteria were patients submitted to surgery for colorectal cancer at the “Hospital Universitari de Girona“ during the period 1999-2001. All surgeries were elective with intention to cure, Dukes D patients were excluded. Patients were grouped by Body Mass Index (BMI) into underweight (<18.5), normalweight (18.5-24.9), preobese (25.0-29.9) and obese (>30.0). 38 different parameters (epidemiological, nutritional, laboratory, histological, surgical, morbidity, comorbidity, short and long term mortality) were studied. We performed an univariate analysis for all patients. One bivariate analysis for BMI and other for long term survival were also performed, and finally a multivariate analysis to asses independent prognostic factors of long term survival. Results: 369 patients, 213 (57.8 %) with colon cancer (CC) and 156 (42.3%) with rectal cancer (RC) were included into the study. 224 (60.7%) male and 145 (39.3%) female, average age were 66.3 years. 7 (1.9%) were underweight, 182 (49.5%) normalweight, 118 (32.1%) preobese and 61 (16.6%) obese. 121 (32.8%) patients had postoperative morbidity, 6 (1.6%) was the first month mortality. There were no statistically significant differences between BMI groups regarding morbidity and mortality, in the first postoperative month, neither in long term survival with a follow up of 13.2 years. Preobese and obese patients have had more preoperative comorbidities (p=0.002), and also higher levels of preoperative serum proteins (p=0.002), albumine (p=0.032) and complement system C3 (p=0.034), meanwhile alpha 1 antitripsine were lower than in normalweight patients (p=0.046). With regard to lymph nodes, patients with higher BMI, had more lymph nodes affected (p=0.041), and more undifferentiated tumours (p=0.011), when the cancer was in the colon, and more lymph nodes affected and higher tumour stage (p=0.023), if the neoplasm was rectal cancer. In multivariate analysis, independent prognostic factors for long term survival were, ASA score, tumour stage, age and surgical technique. Conclusions: Preobesity and obesity, does not have influence in postoperative morbidity or mortality, neither long term survival, of the patients submitted to elective colorectal cancer surgery, although there has been identified influence in other parameters like comorbidities, nutritional status or tumour characteristics.
| Date of Award | 11 Jun 2009 |
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| Original language | Spanish |
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| Awarding Institution | - Universitat Autònoma de Barcelona (UAB)
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| Supervisor | Manuel Armengol Carrasco (Director) & Antoni Codina Cazador (Director) |
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