title: Impact of fat obesity on laparoscopic total mesorectal excision: more reliable indicator than body mass index.
abstract: BACKGROUND
  The aim of this study was to evaluate the impact of visceral fat obesity (VFO) on early surgical and oncologic outcomes of laparoscopic total mesorectal excision (LTME) for rectal cancer.
  
  
  METHODS
  Between June 2003 and June 2009, a total of 142 patients who had undergone LTME were included. Patients were divided into the obese group (OG) and the non-obese group (NOG) according to BMI and visceral fat area (VFA). Obesity was defined by BMI ≥25 kg/m² or VFA ≥130 cm².
  
  
  RESULTS
  There were 37 (26.0%) and 29 (20.4%) obese patients according to BMI and VFA, respectively. The OG, defined by both VFA and BMI, had a significantly longer operative time. The VFO group experienced more frequent conversion to laparotomy (17.2% vs. 5.0%; P = 0.047) and significantly higher blood loss during surgery (205.8 ± 257.0 mL vs. 102.5 ± 219.9 mL; P = 0.031), whereas there was no significant difference when defined by BMI. Time to first flatus was significantly longer in the VFO group compared with the NOG (mean 3.5 days vs. 2.7 days; P = 0.046), whereas it was not significantly different when classified by BMI. Regarding oncologic parameters, the VFO group had a significantly higher number of patients from whom less than 12 total lymph nodes were retrieved (65.5% vs. 34.5%; P = 0.002); however, there was no difference between the two groups defined by BMI.
  
  
  CONCLUSIONS
  VFO is proven to be a more reliable predictive factor than BMI in estimating early surgical outcomes for patients who underwent LTME. VFO is associated with fewer numbers of retrieved lymph nodes.
authors: Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea, 120-752.
authors: Jeonghyun
authors: J
authors: Kang
authors: Song-Ee
authors: SE
authors: Baek
authors: Taehyung
authors: T
authors: Kim
authors: Hyuk
authors: H
authors: Hur
authors: Byung Soh
authors: BS
authors: Min
authors: Joon Seok
authors: JS
authors: Lim
authors: Nam Kyu
authors: NK
authors: Kim
authors: Kang Young
authors: KY
authors: Lee
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003710:Demography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009765:Obesity / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011182:Postoperative Care; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome