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IMPACT OF THE BODY-MASS INDEX ON THE LONG-TERM OUTCOME AFTER RECTAL CANCER RESECTIONS AND DATA OBTAINED IN A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY
Bjoern Gebauer*1,2, Ingo Gastinger1, Henry Ptok1,2, Ralf Steinert1,3, Ronny Otto1, Hans Lippert1, Frank Meyer1,2
1Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University, Magdeburg, Germany; 2Department of General, Abdominal and Vascular Surgery, Otto-von-Guericke University, Magdeburg, Germany; 3Department of General and Abdominal Surgery, St Joseph’s Hospital, Salzkotten, Germany
Objective: The aim of this study was to investigate the impact of overweight and obesity as well as underweight on the long-term survival and local recurrence rate (LRR) after surgical resection for rectal cancer.
Methods: Data was gathered by a German observational study in the field of Quality Assurance called “Rectal cancer (primary tumor) - elective surgery”. All aspects concerning the hospital stay were reported by the clinic where the patient underwent surgery. 68 Items were analyzed and a consecutive follow-up was done. An informed consent was necessary. Patients were separated in four groups: under-, normal-, overweight and obesity - using WHO-definitions. Endpoints were overall survival (OS), disease-free survival (DFS) and LRR after five years. Data from 2008 till 2011 was included.
Results: 9.920 patient-records were eligible for analysis. 2.1% of the patients were underweight, 38.0% normal weight, 40.5% overweight and 19.4% obese, respectively. The average age was 68 (range 21-99) years. UICC tumor stage was more advanced in underweight and less advanced in patients with BMI ≥ 25.0 compared to normal weight ones (P<0.001). The OS after five years (59.0% in total) was lower in underweight patients (36.9%) and higher in overweight (60.9%) and obese ones (61.3%) compared to normal weight (56.9%) (P<0.001 each). Concerning the DFS (58.1% in total) there was no difference between underweight and normal weight patients (P=0.168) but still a better DFS of overweight and obese patients (P<0.05 each). The LRR was observed at 5.2% after five years without significant differences (P>0.05 each). Multivariate analysis showed that patients classified ASA III (HR=1,78 [95%-CI: 1.24-2.56]), ASA IV (HR=3.62 [95%-CI: 2.36-5.57]) compared with ASA I had worse OS as well as older patients (HR65-74y= 1.41 [95%-CI: 1.20-1.65] / HR≥75y=2.17 [95%-CI: 1.85-2.54]) compared to those younger than 65. Advanced tumor stages and specific tumor characteristics were also related with worse OS - including pT3/4, pN1/2, M1, pL1, pV2 status and G4 grading. General (HR=2.42 [95%-CI: 2.14-2.73]) or specific postoperative complications (HR=1.20 [95%-CI: 1.07-1.35]) worsened the OS, too. Patients who received a preoperative bowel preparation (HR=0.86 [95%-CI: 0.75-0.98]) or got an anastomosis created (HR=0,77 [0,69;0,87]) had a better OS. In addition, overweight (HR=0.84 [95%-CI: 0.74-0.95]) and obesity (HR=0.78 [95%-CI: 0.66-0.91]) were also independent factors for a better OS.
Discussion: Underweight patients had a worse OS after resections for rectal cancer. This was at least partly due to higher stage diseases, also because there was no observed difference in DFS compared to normal weight patients. On the other hand, overweight and obesity were independently related to a significantly better long-term survival. The LRR appeared to be not dependent on the patients’ BMI.
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