Simon Xu, Rathin Gosavi, Yigeng Li, James Lim, T C Nguyen, William Teoh, Geraldine Ooi, Vignesh Narasimhan
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Patients were stratified into groups by BMI (obese (BMI≥ 30 kg/m<sup>2</sup>) versus non-obese (BMI < 30 kg/m<sup>2</sup>)). The primary outcome was the incidence and severity of iAEs, graded using the CLASSIntra system. Secondary outcomes included conversion to open surgery, postoperative complications, ICU admissions, and overall length of stay.</p><p><strong>Results: </strong>There were 350 patients included (112 obese, 238 non-obese). There were significantly more iAEs in the obese group (40% vs. 26%, p = 0.010). Obesity was an independent predictor of intraoperative complications (OR 1.92, p = 0.010). Conversion to open surgery (27% vs. 40%, OR 2.30, p = 0.0100) and ICU readmission (50% vs. 31%, OR 2.35, p = 0.003) were significantly more common in patients with obesity. There were no significant differences in postoperative complication rates and hospital length of stay between groups.</p><p><strong>Conclusion: </strong>Obesity leads to a higher risk of intraoperative complications in rectal cancer surgery, increased conversion rates, and greater ICU resource utilisation. These findings highlight the technical challenges of rectal surgery in obese patients and emphasize the need for tailored preoperative planning, prehabilitation, and intraoperative strategies. Despite these intraoperative difficulties, structured postoperative care appears to mitigate differences in postoperative outcomes. Further research should explore preoperative interventions, such as weight optimization programs, to improve surgical outcomes in this high-risk population.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Obesity on Intraoperative Complications in Rectal Cancer.\",\"authors\":\"Simon Xu, Rathin Gosavi, Yigeng Li, James Lim, T C Nguyen, William Teoh, Geraldine Ooi, Vignesh Narasimhan\",\"doi\":\"10.1111/ans.70190\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obesity is a growing global health concern and poses significant challenges in rectal cancer surgery. Excess visceral fat can obscure surgical landmarks, complicate dissection, and increase the risk of intraoperative adverse events (iAEs). 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There were significantly more iAEs in the obese group (40% vs. 26%, p = 0.010). Obesity was an independent predictor of intraoperative complications (OR 1.92, p = 0.010). Conversion to open surgery (27% vs. 40%, OR 2.30, p = 0.0100) and ICU readmission (50% vs. 31%, OR 2.35, p = 0.003) were significantly more common in patients with obesity. There were no significant differences in postoperative complication rates and hospital length of stay between groups.</p><p><strong>Conclusion: </strong>Obesity leads to a higher risk of intraoperative complications in rectal cancer surgery, increased conversion rates, and greater ICU resource utilisation. These findings highlight the technical challenges of rectal surgery in obese patients and emphasize the need for tailored preoperative planning, prehabilitation, and intraoperative strategies. Despite these intraoperative difficulties, structured postoperative care appears to mitigate differences in postoperative outcomes. 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引用次数: 0
摘要
背景:肥胖是一个日益增长的全球健康问题,对直肠癌手术提出了重大挑战。过多的内脏脂肪会模糊手术标志,使解剖复杂化,并增加术中不良事件(iae)的风险。尽管存在这些公认的困难,但量化肥胖对术中并发症影响的客观数据有限。本研究采用CLASSIntra分类系统评估直肠癌切除术中肥胖(BMI≥30 kg/m2)患者iae的发生率和严重程度。方法:本回顾性队列研究回顾了2014年1月至2023年12月期间接受直肠癌切除术的患者。根据BMI(肥胖(BMI≥30 kg/m2)与非肥胖(BMI 2))将患者分层。主要结局是iae的发生率和严重程度,使用CLASSIntra系统进行分级。次要结局包括转开腹手术、术后并发症、ICU入院情况和总住院时间。结果:共纳入350例患者,其中肥胖112例,非肥胖238例。肥胖组iae发生率明显高于肥胖组(40% vs. 26%, p = 0.010)。肥胖是术中并发症的独立预测因子(OR 1.92, p = 0.010)。肥胖患者转开手术(27%对40%,OR 2.30, p = 0.0100)和ICU再入院(50%对31%,OR 2.35, p = 0.003)更为常见。两组术后并发症发生率及住院时间无显著差异。结论:肥胖导致直肠癌手术术中并发症风险增加,转换率增加,ICU资源利用率提高。这些发现突出了肥胖患者直肠手术的技术挑战,并强调了量身定制的术前计划、康复和术中策略的必要性。尽管存在这些术中困难,结构化的术后护理似乎减轻了术后结果的差异。进一步的研究应该探索术前干预措施,如体重优化方案,以改善这一高危人群的手术效果。
The Impact of Obesity on Intraoperative Complications in Rectal Cancer.
Background: Obesity is a growing global health concern and poses significant challenges in rectal cancer surgery. Excess visceral fat can obscure surgical landmarks, complicate dissection, and increase the risk of intraoperative adverse events (iAEs). Despite these recognized difficulties, there is limited objective data quantifying the impact of obesity on intraoperative complications. This study utilizes the CLASSIntra classification system to assess the incidence and severity of iAEs in patients with obesity (BMI ≥ 30 kg/m2) undergoing rectal cancer resection.
Methods: This retrospective cohort study reviewed patients undergoing rectal cancer resection between January 2014 and December 2023. Patients were stratified into groups by BMI (obese (BMI≥ 30 kg/m2) versus non-obese (BMI < 30 kg/m2)). The primary outcome was the incidence and severity of iAEs, graded using the CLASSIntra system. Secondary outcomes included conversion to open surgery, postoperative complications, ICU admissions, and overall length of stay.
Results: There were 350 patients included (112 obese, 238 non-obese). There were significantly more iAEs in the obese group (40% vs. 26%, p = 0.010). Obesity was an independent predictor of intraoperative complications (OR 1.92, p = 0.010). Conversion to open surgery (27% vs. 40%, OR 2.30, p = 0.0100) and ICU readmission (50% vs. 31%, OR 2.35, p = 0.003) were significantly more common in patients with obesity. There were no significant differences in postoperative complication rates and hospital length of stay between groups.
Conclusion: Obesity leads to a higher risk of intraoperative complications in rectal cancer surgery, increased conversion rates, and greater ICU resource utilisation. These findings highlight the technical challenges of rectal surgery in obese patients and emphasize the need for tailored preoperative planning, prehabilitation, and intraoperative strategies. Despite these intraoperative difficulties, structured postoperative care appears to mitigate differences in postoperative outcomes. Further research should explore preoperative interventions, such as weight optimization programs, to improve surgical outcomes in this high-risk population.
期刊介绍:
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.