| Objective:To explore the effects of physical parameters such as visceral fat areas,subcutaneous fat areas,visceral fat area/subcutaneous fat area ratio and body mass index on laparoscopic assisted radical resection of colorectal cancer.Methods:The clinical data of 129 patients with laparoscopic assisted resection of colorectal cancer in the department of general surgery of Tianjin Medical University General Hospital from January 2015 to September 2017 were retrospectively analyzed.The images of L4-L5 range were captured by CT thin layer scanning,VFA and SFA were measured with specific scanning software,and V/S was calculated.BMI was calculated by weight divided by the square of height.All the patients were grouped according to physical parameters,the cutoff value of visceral fat area was100cm~2,and the cutoff value of the subcutaneous fat area was 207.62 cm~2,and the visceral fat area/subcutaneous fat area was 0.4,body mass index was 24 kg/m~2.To compare the influence of VFA,SFA,V/S and BMI during operation(operation time,intraoperative blood loss,conversion rate,number of retrieved lymph nodes),ventilator usage time,first flatus and first feeding time after surgery,postoperative hospital stay,operation related complications(wound infection,abdominal infection,pulmonary infection,anastomotic leakage and intestinal obstruction)within 1 months after the operation,the effects of physical parameters on postoperative complications were discussed.Result:The patients were grouped by VFA,SFA,V/S and BMI,the number of the low and high groups was 75/55,72/57,109/20 and 71/58.We compared the difference of surgical effect between different groups,compared with the low VFA group,the operation time of the high VFA group was significantly longer[(291.10±56.40)min vs(254.4±58.2)min,P=0.000],number of retrieved lymph nodes was less[(13.85±3.09)vs(15.15±3.68),P=0.032],the conversion rate was increased significantly[12.16%(9/74)vs 1.82%(1/55),P=0.028],longer hospital stay after surgery[(18.97±11.19)d vs(14.78±6.05)d,P=0.012],and increased incidence of complications within 1 months after surgery[32.00%vs 16.36%,P=0.030].But there was no significant difference in intraoperative blood loss,ventilator usage time,postoperative first flatus and first feeding time after surgery(P>0.05).But with SFA,V/S and BMI groups,although the higher group had longer operation time,less lymph nodes number harvested,longer duration of ventilator use,postoperative exhaust and feeding time and total hospitalization time were prolonged,but there was no statistically significant difference between each groups(P>0.05).All of the patients were followed up for 1 months after operation to analyze the incidence of complications within 1 months after the operation.There were 33 cases of postoperative complications.Among them,the most common wound infection,18cases,13.95%,followed by abdominal infection and anastomotic leakage,were 8cases(6.20%),and pulmonary infection(5 cases,3.88%)and intestinal obstruction(5cases,3.88%).Multivariate analysis showed that differences in VFA were independent risk factors for complications within 1 months after surgery(OR 2.87,95%CI 1.05-7.94,P=0.040).Conclusions:Patients with significant higher physical parameters than normal range may affect the surgical effect of laparoscopic radical resection of colorectal cancer.Compared with SFA,V/S,BMI and other physical parameters,VFA can be more accurate predicting the effect of colorectal cancer patients.Although patients with high VFA can benefit from laparoscopic radical resection of colorectal cancer,they may take more risk of surgery.Therefore,standardized surgical procedure should be performed and more attention should be paid to the perioperative management of patients with high VFA. |
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