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. 2022 Aug;37(8):1893-1900.
doi: 10.1007/s00384-022-04221-8. Epub 2022 Jul 28.

Visceral-to-subcutaneous fat ratio exhibits strongest association with early post-operative outcomes in patients undergoing surgery for advanced rectal cancer

Gabriele Bocca #  1 , Sotiris Mastoridis #  2 , Trevor Yeung  3   2 , David R C James  3 , Chris Cunningham  3   2
Affiliations

Visceral-to-subcutaneous fat ratio exhibits strongest association with early post-operative outcomes in patients undergoing surgery for advanced rectal cancer

Gabriele Bocca et al. Int J Colorectal Dis. 2022 Aug.

Abstract

Aim: Despite their promise as prognostic factors in colorectal cancer, anthropometric data are frequently contradictory or difficult to interpret, with single body-composition parameters often investigated in isolation or heterogeneous clinical cohorts used in analyses. We sought to assess a spectrum of body-composition parameters in a highly selected cohort with locally advanced rectal cancer in a bid to determine those with strongest prognostic potential in this specific setting.

Materials/methods: Between 2014 and 2020, 78 individuals received neoadjuvant chemotherapy, or chemoradiotherapy, followed by radical surgery in the treatment of locally advanced rectal adenocarcinoma at Oxford University Hospitals Trust. Demographic, treatment-related, perioperative, and short-term outcomes data were assessed. Body-composition parameters included BMI, and those derived from pre-operative computed-tomography imaging: skeletal mass index (SMI), visceral fat area (VFA), subcutaneous fat area (SFA), perinephric fat area (PFA) visceral-to-subcutaneous fat ratio (V/S), sarcopenia, and sarcopenic obesity (SO).

Results: Pre-operative body-composition parameters exhibited particularly strong correlation with post-operative outcomes, with VFA (p = 0.002), V/S (p = 0.019), SO (p = 0.012), and PFA (p = 0.0016) all associated with an increased length of hospital stay. Univariate and multivariate analyses demonstrated V/S to be the sole independent body-composition risk factor to be associated with an increased risk of developing Clavien-Dindo complications ≥ 2 (p = 0.033) as well as an increased length of stay (p = 0.005).

Conclusion: Among patients with locally advanced rectal cancer, high visceral-to-subcutaneous fat ratio is the body-composition parameter most strongly associated with poor early post-operative outcomes. This should be considered in patient selection and prehabilitation protocols. WHAT DOES THIS PAPER ADD TO THE LITERATURE? : Our study demonstrates that among body composition parameters, high visceral-to-subcutaneous fat ratio is strongly associated with increased risk of post-operative complications and increased length of stay in patients undergoing surgery for advanced rectal cancer.

Keywords: Advanced rectal cancer; Body composition parameters; Prehabilitation; Surgical outcomes; Visceral-to-subcutaneous fat ratio.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Representative CT scans assessed using CoreSlicer with the following body parameters highlighted: visceral fat (VFA, yellow), skeletal muscle (red), subcutaneous fat (SFA, blue). Examples of patients with A high VFA, low SFA; B low VFA, low SFA; C high VFA, high SFA
See this image and copyright information in PMC

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