ABSTRACT
BACKGROUND: Complications after rectal resection are frequent. Recently, methods to assess visceral obesity (VO) have become available as an alternative to measurement of body mass index (BMI). The aim of this study was to examine the association between visceral fat volume (VFV) and the short-term outcomes after laparoscopic low anterior resection (LLAR) in patients with rectal cancer. METHODS: We studied a consecutive series of patients undergoing LLAR at Bispebjerg University Hospital from 01.01.2013 to 01.01.2016. Preoperative VFV was calculated from abdominal CT scans using an automatic segmentation tool. The primary outcome was anastomotic leakage (AL). Secondary outcomes included conversion to open surgery, number of lymph nodes harvested, the rates of 30-day complications as well as reoperations, and 1-year survival. RESULTS: A total of 102 patients were included. VO was defined as a VFV above the 75 percentile. Thirteen (12.7%) patients developed AL, four (15.4%) of whom were in the VO group (p = 0.900). At least one postoperative complication developed in 38 (37.3%) patients, with no significant difference between the VO and non-VO patients after univariable analysis (42.3% vs. 35.4%, p = 0.702) or multivariable adjustment (OR 1.01, 95% CI 0.38-2.65, p = 0.984). VO was significantly associated with an increased incidence of conversion to open surgery (OR 4.30, 95% CI 1.29-14.86, p = 0.018). There was a significant difference in the number of harvested lymph nodes between the two groups (mean 23.5 vs. 29.1, p = 0.045). CONCLUSIONS: In this study on patients undergoing laparoscopic rectal resection, VO was not associated with development of AL or other complications. However, we found that visceral obesity was associated with an increased risk of conversion to open surgery.
Subject(s)
Anastomotic Leak , Intra-Abdominal Fat/pathology , Laparoscopy , Obesity, Abdominal , Postoperative Complications , Proctectomy , Rectal Neoplasms , Anastomotic Leak/epidemiology , Anastomotic Leak/etiology , Body Mass Index , Conversion to Open Surgery/statistics & numerical data , Female , Humans , Incidence , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Middle Aged , Obesity, Abdominal/diagnosis , Obesity, Abdominal/epidemiology , Organ Size , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Proctectomy/adverse effects , Proctectomy/methods , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Retrospective Studies , Risk Adjustment/methodsABSTRACT
Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a normal D-dimer, DVT was verified by colour Doppler ultrasound in both cases. The guidelines of American College of Chest Physicians recommend initial evaluation using colour Doppler ultrasound as front-line examination. Accordingly, we suggest a similar revision of Danish guidelines incorporating upper extremity DVT as well.
