Johanna Nattenmueller MD, Presenter: Nothing to Disclose

Jurgen Staffa, Abstract Co-Author: Nothing to Disclose

Astrik Bagdassarjan, Abstract Co-Author: Nothing to Disclose

Yakup Kulu, Abstract Co-Author: Nothing to Disclose

Biljana Gigic, Abstract Co-Author: Nothing to Disclose

Hans-Ulrich Kauczor MD, Abstract Co-Author: Research Grant, Boehringer Ingelheim GmbH Research Grant, Siemens AG Research Grant, Bayer AG Speakers Bureau, Boehringer Ingelheim GmbH Speakers Bureau, Siemens AG Speakers Bureau, Novartis AG

Martin A. Schneider, Abstract Co-Author: Nothing to Disclose

Cornelia Ulrich PhD, Abstract Co-Author: Nothing to Disclose

Alexis Ulrich, Abstract Co-Author: Nothing to Disclose

Obesity is associated with an increased incidence and mortality in rectal cancer (RC). However, an obesity paradox in the sense of a protective effect of adipose tissue is described in many chronic diseases. We evaluated whether there is an impact of total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and BMI on morbidity including medical and surgical complications after RC surgery. 

In 329 patients with RC (98 female, 231 male; mean age 63.0 (SD 12), mean BMI 26.0 kg/m2 (SD 5) with 218 obese patients BMI >25 kg/m2) who underwent multi-detector-CT, area-based quantification of TAT, VAT, SAT & RatioVAT/SAT was performed on levels L3/4 & L4/5, and volume-based quantification from T11/12 to L5/S1 (abd) and L5/S1 to symphysis (pelv), between -190 to -30 HU. Logistic regressions of TAT, VAT, SAT and RatioVAT/SAT on surgical complications [total n=107, anastomotic leakage (AL, n=27), wound infection (WI, n=57), bleeding (n=12), abscess (n=26), bladder dysfunction (BD, n=25), burst abdomen (BA, n=9)] and medical complications [total n=47, cardiac (n=18), pulmonary (n=22)] were performed. 

A significant increase was seen in overall medical complications for TAT (pabd=0.03; ppelv=0.003) and SAT (pabd= 0.02; ppelv= 0.002); in cardiac complications for TAT (pabd= 0.02, ppelv= 0.01), VAT (pabd= 0.03) and SAT (ppelv= 0.02); in AL for VAT (ppelv= 0.02) and SAT (pL4/5= 0.04); in WI for TAT (pabd= 0.02, ppelv= 0.02) and SAT (pabd= 0.04, ppelv= 0.01); in BD for TAT (pabd= 0.03) and VAT (pabd= 0.02, PL3/4= 0.02); in BA for TAT (pabd=0.003, ppelv=0.002, pL3/4= 0.007, pL4/5= 0.004), VAT (pabd=0.005, pL3/4= 0.01, pL4/5=0.03), SAT (pabd=0.006, ppelv=0.002, pL3/4= 0.03, pL4/5= 0.007) and RatioVAT/SAT (pL4/5= 0.01). No association was seen with pulmonary or overall surgical complications, bleeding and abscess. BMI showed no association with any complication.   

In contrast to BMI, an increase in adipose tissue compartments measured in CT is able to predict complications after RC surgery. No obesity paradox was observed in the sense of a protective effect of adipose tissue.

Quantification of adipose tissue compartments, based on routine CT scans, could (in contrast to BMI) help identify patients at risk for complications following RC surgery, aiming to prevent these. 

Nattenmueller, J, Staffa, J, Bagdassarjan, A, Kulu, Y, Gigic, B, Kauczor, H, Schneider, M, Ulrich, C, Ulrich, A, CT-quantified Obesity a Risk or Protective Factor for Complications after Rectal Cancer Surgery?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012591.html