Abstract
BackgroundThe escalating global epidemic of obesity is of worldwide concern because of its association with serious negative effects on health. The technical difficulty of rectal cancer surgery is exacerbated in obese patients, which may compromise outcomes. High-quality, relevant evidence is limited. This meta-analysis aims to assess the outcomes of rectal cancer surgery in obese and nonobese patients.MethodsThe electronic databases Pubmed, Medline, Embase, Web of Science, and the Cochrane Library were used to search for articles that evaluated the outcomes of rectal cancer surgery in obese and nonobese patients. Fixed-effects and random-effects models were used to calculate the combined overall effect sizes of pooled data. Data are presented as odds ratios (OR) or weighted mean differences (WMD) with 95 % confidence intervals (CIs).ResultsTen appropriate observational studies were identified from 290 published articles. In the obese group, conversion rates (OR 2.78; 95 % CI 1.67–4.61), overall morbidity (OR 1.36; 95 % CI 1.25–1.47), anastomotic leak (OR 3.94; 95 % CI 1.88–8.24), wound infection (OR 2.22; 95 % CI 1.47, 3.36), and pulmonary events (OR 2.10; 95 % CI 1.18, 3.74) were all significantly increased. For pathological results, no statistical differences in the number of harvested lymph nodes and the positive margin were noted between the two groups.ConclusionsBased on a meta-analysis, obesity increases the conversion rate and postoperative morbidity of rectal cancer surgery but does not influence pathological results.
Highlights
The escalating global epidemic of obesity is of worldwide concern because of its association with serious negative effects on health
We identified 45 potentially eligible articles that evaluated the impact of obesity on the outcomes of rectal cancer surgery
All of the studies used Body mass index (BMI) as a measure of obesity and nonobesity; the cutoff points used to categorize BMI varied among the studies
Summary
The escalating global epidemic of obesity is of worldwide concern because of its association with serious negative effects on health. The technical difficulty of rectal cancer surgery is exacerbated in obese patients, which may compromise outcomes. This meta-analysis aims to assess the outcomes of rectal cancer surgery in obese and nonobese patients. Whether a higher BMI can compromise surgical outcomes in patients with rectal cancer is unclear. Rectal cancer surgery presents unique challenges; the limited size of the pelvic cavity, necessity for extensive yet precise dissection, and the proximity of other major anatomic structures, all contribute to a complication rate that has been reported at 30 to 50 %, substantially higher than the 10 to 12 % cited for general surgery procedures overall [4,5,6]. High BMI may be assumed to increase the technical difficulty of rectal cancer surgery. Some studies suggested that patients with higher BMI had significantly more conversions to an open procedure, more postoperative complications, and a higher morbidity rate after rectal cancer resection, whereas others yielded conflicting
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