624 Implementation of Best Practices in Colorectal Surgery at a Safety Net Hospital: Facilitators and Barriers

Abstract

S A T A b st ra ct s females (age 62.0±10.8 years). Median follow up period was 67.3+/-17.8months (range:12.3102.2months). CT scans were available in 651 patients (CT follow up duration : median 44.6months, range 12.3-82.8months). Preoperative VAT obesity was observed in 323 patients (49.4%) and SAT obesity in 266 (47%). Preoperative VAT obesity was associated with earlier TNM stage (p=0.042) and negative venous invasion (p=0.02). After surgery, 266 patients (53%) showed increase in VAT, and 358 patients (63.3%) in SAT after surgery. Chemotherapy did not influence in VAT or SAT changes (p=0.086). Increase in VAT amount after surgery was associated with pathologic differentiation and increase in SAT with T stage and TNM stage. By Kaplan Meier analysis, increased VAT and SAT after surgery showed higher OS (p=0.001, 0.03) and DFS (p=0.004, 0.02) in stage 3. On univariate analysis, TNM stage, pathologic differentiation, perineural invasion, preoperative CEA level, postoperative VAT and SAT change were significant predictors of OS and DFS. Preoperative VAT obesity was not associated with OS (p=0.148) and DFS (p=0.615). By multivariate Cox regression analysis, TNM stage (p=0.049), differentiation (p=0.006), perineural invasion (p=0.000) and postoperative VAT change (HR, decrease : increase = 1 : 0.493, p=0.012) were significant predictors for OS and DFS. Conclusions> In contrary to other studies, preoperative visceral obesity was not a predictor for poor prognosis in our cohort of patients. Instead, the increase in visceral fat amount after surgery was a significant positive predictor of overall and disease free survival in CRC patients undergoing curative resection.