title: Impact of obesity on short-term results of laparoscopic rectal cancer resection.
abstract: BACKGROUND
  The influence of obesity [body mass index (BMI) >or= 30 kg/m(2)] on the outcome of laparoscopic colorectal surgery remains controversial. The complexity of rectal laparoscopic resections requires a specific assessment of the impact of obesity on the feasibility and short-term results of the surgery.
  
  
  METHODS
  Between February 2002 and May 2007, 210 laparoscopic mesorectal excisions were performed. Demographic, oncologic and perioperative data were entered in a prospective database. Twenty-four patients (11.4%) with BMI over 30 kg/m(2) formed the obese group (OG). The outcomes in the OG and the nonobese group (NOG) were compared.
  
  
  RESULTS
  There were significantly more American Society of Anesthesiologists (ASA) score 3 patients (26% in OG versus 9% in NOG; p = 0.03) in the obese group. Obese patients experienced longer operative times (513 min in OG vs. 421 min in NOG; p < 0.01) and more frequent conversion to laparotomy (46% in OG vs. 12% in NOG; p < 0.001). Morbidity grade 1 was higher in the obese group (29.2% vs. 9.7% in NOG; p = 0.01), but there was no difference in regards to morbidity grade 2 or more (33.3% in OG vs. 32.3% in NOG). In addition, conversion to laparotomy among the obese did not increase significantly morbidity grade 2 or higher (5 of 11 for OG converted vs. 3 of 13 for OG nonconverted; p = 0.39). Regarding the oncological parameters (e.g. number of lymph nodes removed, distal and lateral margins) there was no difference between groups.
  
  
  CONCLUSIONS
  Obesity increases operative duration and conversion rate of rectal laparoscopic resection for cancer. Although obesity is associated with a worse preoperative evaluation, there is no increase in relevant morbidity and no impairment of oncological safety.
authors.affiliation: Department of Surgical Oncology, Institut Paoli Calmettes, Université de la Méditerranée, Marseille, France. tbege@hotmail.com
authors.forename: Thierry
authors.initials: T
authors.lastname: Bège
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Daniel
authors.initials: D
authors.lastname: Francon
authors.forename: Olivier
authors.initials: O
authors.lastname: Turrini
authors.forename: Jérome
authors.initials: J
authors.lastname: Guiramand
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000209:etiology; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome