title: Visceral obesity, body mass index and risk of complications after colon cancer resection: A retrospective cohort study.
abstract: BACKGROUND
  The aim of our study was to assess the influence of visceral obesity (VO), as measured by preoperative abdominal CT scan, in relation to body mass index (BMI) on the incidence of postoperative complications and duration of hospital stay after colon cancer surgery.
  
  
  METHODS
  Patients who underwent elective resection for colon cancer between January 1, 2006, and December 31, 2013, and had a preoperative CT scan were entered in the study. Visceral fat area (VFA) was determined by using the preoperative CT scan at the L3-L4 level. The effect of VO, defined as a VFA of >100 cm², on postoperative complications and duration of hospital stay was analyzed.
  
  
  RESULTS
  Of 564 included patients, 65% had VO. VO was associated with more anastomotic leakage (P = .04), pneumonia (P = .02), wound infection (P = .03), reoperations (P = .04), and longer duration of hospital stay (P = .05). Of patients with a BMI < 25 kg/m², 44% had VO. In this group, VO was associated significantly with postoperative complications, cardiac (P < .01) and pulmonary (P = .01) comorbidity, hypertension (P < .01), and diabetes (P < .01). In the overweight (BMI 25-30 kg/m²) and obese (BMI > 30 kg/m²) groups, the rate of VO was much higher (81% and 90%, respectively), but was not associated significantly with complications or comorbidity, except for cardiac comorbidity (P < .02) in the BMI = 25-30 kg/m² group. After multivariable analysis, VO was shown to be an independent predictor of anastomotic leakage and wound infection.
  
  
  CONCLUSIONS
  The association of VO with worse outcome after colon cancer surgery is most pronounced in patients with a BMI < 25 kg/m².
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Hamit
authors.initials: H
authors.lastname: Cakir
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Colin
authors.initials: C
authors.lastname: Heus
authors.affiliation: Trial Center Holland Health, Alkmaar, The Netherlands.
authors.forename: Wouter M
authors.initials: WM
authors.lastname: Verduin
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: Lak
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands; Trial Center Holland Health, Alkmaar, The Netherlands.
authors.forename: Hieronymus J
authors.initials: HJ
authors.lastname: Doodeman
authors.affiliation: Department of Surgery, the Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands; Trial Center Holland Health, Alkmaar, The Netherlands. Electronic address: a.p.j.houdijk@mca.nl.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Houdijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies