Impact of Body Mass Index on Short-Term Outcomes after Intersphincteric Resection for Rectal Cancer and Anal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIONG Tianyuan ^1,2 , GAN Zhiming ^1,2 , WANG Xiaodong ^1,2 ,  LI Li ^1,2

1.Department of Gastrointestinal Surgery，West China Hospital，Sichuan University，Chengdu 610041，Sichuan Province，China;;
2.West China Medical School/MCQ Group of West China Hospital，Sichuan University，Chengdu 610041，Sichuan Province，China;

Corresponding author：

LI Li, Email: drlili116@126.com

Keywords：

Rectal cancer; Anal cancer; Body mass index; Intersphincteric resection; Short-term outcome

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Objective 　To evaluate the impact of body mass index （BMI） on short-term outcomes after intersphi-ncteric resection （ISR） for rectal cancer and anal cancer.
Methods 　One hundred and ninety-nine cases of rectal cancer and anal cancer who were treated in Department of Gastrointestinal Surgery of West China Hospital of Sichuan University from Jan. 2009 to Dec. 2011 were enrolled retrospectively，and these cases were divided into underweight group （n=23），normal group （n=114），and overweight group （n=62） according to BMI. Postoperative indexes in early rehabilitation and complication of 3 groups were studied and compared.
Results 　On the recovery indexes after ISR in early stage，there were no significant differences on the duration of first flatus，first defecation，first oral intake，first ambulation，and hospital stay among 3 groups （P＞0.05）. On the tube management，there were no significant differences on the duration of pulling out nasogastric tube and urinary catheter （P＞0.05），but duration of pulling out drain was longer in normal group and over-weight group （P＜0.05）. There were no significant differences on the incidence of postoperative complications among the 3 groups （P＞0.05），including anastomotic leakage，anastomotic bleeding，perianal infection，ileus，gastric retention，urinary retention， septicemia，wound infection，and recto-vaginal fistula.
Conclusions 　BMI has little impact on short-term outcomes after ISR. Obesity does not increase the incidence of common complications for patients after ISR and does not influence recovery indexes with proper postoperative managements.

Citation： XIONG Tianyuan,GAN Zhiming,WANG Xiaodong,LI Li. Impact of Body Mass Index on Short-Term Outcomes after Intersphincteric Resection for Rectal Cancer and Anal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 632-637. doi: Copy

1.	Andersson SO， Wolk A， Bergström R， et al. Body size and prostatecancer：a 20-year follow-up study among 135 006 Swedish constr-uction workers[J]. J Natl Cancer Inst， 1997， 89(5)：385-389.
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4.	Ford ES. Body mass index and colon cancer in a national sampleof adult US men and women[J]. Am J Epidemiol， 1999， 150 (4)：390-398.
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13.	Martinez ME， Giovannucci E， Spiegelman D， et al. Leisure-time physical activity， body size， and colon cancer in women. Nurses’ Health Study Research Group[J]. J Natl Cancer Inst， 1997， 89(13)：948-955.
14.	Ito M， Saito N， Sugito M， et al. Analysis of clinical factors asso-ciated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum， 2009， 52(1)：64-70.
15.	Akasu T， Takawa M， Yamamoto S， et al. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma[J]. J Gastrointest Surg， 2010， 14(1)：104-111.
16.	Lim SW， Huh JW， Kim YJ， et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. World J Surg， 2011， 35(12)：2811-2817.
17.	Blee TH， Belzer GE， Lambert PJ. Obesity：is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma?[J]. Am J Surg， 2002， 68(2)：163-166.
18.	Gao RN， Neutel CI， Wai E. Gender differences in colorectal cancerincidence， mortality， hospitalizations and surgical procedures in Canada[J]. J Public Health (Oxf)， 2008， 30(2)：194-201.
19.	高强，窦倩慧，方超，等. 影响结肠癌患者术后并发症的多因素分析[J]. 中国普外基础与临床杂志， 2011， 18(2)：159-163.
20.	Dindo D， Muller MK， Weber M， et al. Obesity in general electivesurgery[J]. Lancet， 2003， 361(9374)：2032-2035.
21.	Meyerhardt JA， Niedzwiecki D， Hollis D， et al. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage Ⅲ colon cancer：findings from Cancer and Leukemia Group B 89803[J]. J Clin Oncol， 2008， 26(25)：4109-4115.
22.	Mullen JT， Davenport DL， Hutter MM， et al. Impact of body mass index on perioperative outcomes in patients undergoing majorintra-abdominal cancer surgery[J]. Ann Surg Oncol， 2008， 15(8)：2164-2172.
23.	Mcardle CS， Mcmillan DC， Hole DJ. Male gender adversely affects survival following surgery for colorectal cancer[J]. Br J Surg， 2003， 90(6)：711-715.
24.	郝晋，杨廷翰，蒲怡，等. 快速流程模式下术后限制补液对吻合口愈合的影响[J]. 中国医师杂志， 2011， 13(10)：1309-1312.
25.	赵娜，杨廷翰，郝晋，等. 高风险结直肠癌患者快速流程模式的临床应用[J]. 中国现代普通外科进展， 2011， 14(4)：269-272.
26.	汪晓东，谢尧，肖军，等. 快速流程在结直肠外科手术后管理中的应用[J]. 中国普通外科杂志， 2008， 17(4)：394-396.

1. Andersson SO， Wolk A， Bergström R， et al. Body size and prostatecancer：a 20-year follow-up study among 135 006 Swedish constr-uction workers[J]. J Natl Cancer Inst， 1997， 89(5)：385-389.
2. Carmichael AR， Bates T. Obesity and breast cancer：a review of the literature[J]. Breast， 2004， 13(2)：85-92.
3. Bergström A， Pisani P， Tenet V， et al. Overweight as an avoidablecause of cancer in Europe[J]. Int J Cancer， 2001， 91(3)：421-430.
4. Ford ES. Body mass index and colon cancer in a national sampleof adult US men and women[J]. Am J Epidemiol， 1999， 150 (4)：390-398.
5. Shike M. Body weight and colon cancer[J]. Am J Clin Nutr， 1996， 63(3 Suppl)：442S-444S.
6. Rullier E， Laurent C， Garrelon JL， et al. Risk factors for anastomotic leakage after resection of rectal cancer[J]. Br J Surg， 1998， 85(3)：355-358.
7. Benoist S， Panis Y， Alves A， et al. Impact of obesity on surgicaloutcomes after colorectal resection[J]. Am J Surg， 2000， 179 (4)：275-281.
8. 吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状[J]. 中国普外基础与临床杂志， 2007， 14(6)：713-715.
9. 李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠癌手术治疗指南(一)[J]. 中国普外基础与临床杂志， 2008， 15(10)：778.
10. Kehlet H. Fast-track colorectal surgery[J]. Lancet， 2008， 371 (9615)：791-793.
11. World Health Organization. Physical status：the use and interpretation of anthropometry. Report of a WHO Expert Committee[J]. World Health Organ Tech Rep Ser， 1995， 854：1-452.
12. Calle EE， Rodriguez C， Walker-Thurmond K， et al. Overweight，obesity， and mortality from cancer in a prospectively studied cohortofU.S. adults[J]. N Engl J Med， 2003， 348(17)：1625-1638.
13. Martinez ME， Giovannucci E， Spiegelman D， et al. Leisure-time physical activity， body size， and colon cancer in women. Nurses’ Health Study Research Group[J]. J Natl Cancer Inst， 1997， 89(13)：948-955.
14. Ito M， Saito N， Sugito M， et al. Analysis of clinical factors asso-ciated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum， 2009， 52(1)：64-70.
15. Akasu T， Takawa M， Yamamoto S， et al. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma[J]. J Gastrointest Surg， 2010， 14(1)：104-111.
16. Lim SW， Huh JW， Kim YJ， et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. World J Surg， 2011， 35(12)：2811-2817.
17. Blee TH， Belzer GE， Lambert PJ. Obesity：is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma?[J]. Am J Surg， 2002， 68(2)：163-166.
18. Gao RN， Neutel CI， Wai E. Gender differences in colorectal cancerincidence， mortality， hospitalizations and surgical procedures in Canada[J]. J Public Health (Oxf)， 2008， 30(2)：194-201.
19. 高强，窦倩慧，方超，等. 影响结肠癌患者术后并发症的多因素分析[J]. 中国普外基础与临床杂志， 2011， 18(2)：159-163.
20. Dindo D， Muller MK， Weber M， et al. Obesity in general electivesurgery[J]. Lancet， 2003， 361(9374)：2032-2035.
21. Meyerhardt JA， Niedzwiecki D， Hollis D， et al. Impact of body mass index and weight change after treatment on cancer recurrence and survival in patients with stage Ⅲ colon cancer：findings from Cancer and Leukemia Group B 89803[J]. J Clin Oncol， 2008， 26(25)：4109-4115.
22. Mullen JT， Davenport DL， Hutter MM， et al. Impact of body mass index on perioperative outcomes in patients undergoing majorintra-abdominal cancer surgery[J]. Ann Surg Oncol， 2008， 15(8)：2164-2172.
23. Mcardle CS， Mcmillan DC， Hole DJ. Male gender adversely affects survival following surgery for colorectal cancer[J]. Br J Surg， 2003， 90(6)：711-715.
24. 郝晋，杨廷翰，蒲怡，等. 快速流程模式下术后限制补液对吻合口愈合的影响[J]. 中国医师杂志， 2011， 13(10)：1309-1312.
25. 赵娜，杨廷翰，郝晋，等. 高风险结直肠癌患者快速流程模式的临床应用[J]. 中国现代普通外科进展， 2011， 14(4)：269-272.
26. 汪晓东，谢尧，肖军，等. 快速流程在结直肠外科手术后管理中的应用[J]. 中国普通外科杂志， 2008， 17(4)：394-396.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Impact of Body Mass Index on Short-Term Outcomes after Intersphincteric Resection for Rectal Cancer and Anal Cancer

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