title: Laparoscopic colorectal cancer resections in the obese: a systematic review.
abstract: Laparoscopic colorectal cancer operations in obese patients pose technical challenges that may negatively impact oncologic adequacy. A meta-analysis was performed to assess the oncologic outcomes of laparoscopic colorectal cancer resections in obese compared to non-obese patients. Short- and long-term outcomes were assessed secondarily.
  
  
  
  A systematic literature search was conducted from inception until October 01, 2014. Studies that compared outcomes of laparoscopic colorectal malignant neoplasms in obese and non-obese patients were selected for meta-analysis. Studies that defined obesity as body mass index (BMI) ≥ 30 kg/m2were included. Oncologic, operative, and postoperative outcomes were evaluated. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95 % confidence intervals (CI) were calculated using fixed-effects models. For oncologic and survival outcomes, a subgroup analysis was conducted for rectal cancer and a secondary analysis was conducted for Asian studies that used a BMI cutoff of 25 kg/m2.
  
  
  
  Thirteen observational studies with a total of 4550 patients were included in the meta-analysis. Lymph node retrieval, distal, and circumferential margins, and 5-year disease-free and overall survival were similar in the obese and non-obese groups. Conversion rate (OR 2.11, 95 % CI 1.58-2.81), postoperative morbidity (OR 1.54, 95 % CI 1.21-1.97), wound infection (OR 2.43, 95 % CI 1.46-4.03), and anastomotic leak (OR 1.65, 95 % CI 1.01-2.71) were all significantly increased in the obese group.
  
  
  
  Laparoscopic colorectal cancer operations in obese patients pose an increased technical challenge as demonstrated by higher conversion rates and higher risk of postoperative complications compared to non-obese patients. Despite these challenges, oncologic adequacy of laparoscopic colorectal cancer resections is comparable in both groups.
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.
authors: Alastair
authors: A
authors: Fung
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.|Department of Surgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
authors: Nora
authors: N
authors: Trabulsi
authors: Schulich Library of Science and Engineering, McGill University, Montreal, Canada.
authors: Martin
authors: M
authors: Morris
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.
authors: Richard
authors: R
authors: Garfinkle
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.|Department of Surgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
authors: Abdulaziz
authors: A
authors: Saleem
authors: Department of Colorectal Surgery, Cleveland Clinic, Weston, FL, USA.
authors: Steven D
authors: SD
authors: Wexner
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.
authors: Carol-Ann
authors: CA
authors: Vasilevsky
authors: Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada. mboutros@jgh.mcgill.ca.
authors: Marylise
authors: M
authors: Boutros
mesh_terms: D057868:Anastomotic Leak; D015179:Colorectal Neoplasms / Q000601:surgery*; D061887:Conversion to Open Surgery; D006801:Humans; D010535:Laparoscopy; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications; D013530:Surgical Wound Infection
keywords: Cancer resections; Colorectal; Laparoscopic; Minimally invasive; Obese; Open; Outcomes