Techniques in coloproctology · 2026
Short- and long-term outcomes of minimally invasive total mesorectal excision in obese versus nonobese patients with rectal cancer: a propensity score matched study.
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Chen G-Y, Tsai K-Y, Liao C-K, You J-F, Lai C-C, Huang S-H
Аннотация
BACKGROUND: Obesity adds technical complexity to colorectal surgery and has been linked to higher rates of perioperative complications and poorer long-term outcomes. Its prevalence is increasing among patients undergoing minimally invasive total mesorectal excision for rectal cancer; however, its impact on perioperative and oncologic outcomes remains controversial. Therefore, the aim of this study was to compare short- and long-term outcomes between obese (body mass index (BMI) ≥ 27 kg/m2) and nonobese patients undergoing minimally invasive total mesorectal excision.
METHODS: Retrospective review of patients with rectal cancer undergoing laparoscopic, robotic, or transanal total mesorectal excision (TME) between January 2015 and December 2022. Propensity score matching (1:1) was performed on baseline characteristics. Primary outcomes included perioperative parameters, postoperative complications, and long-term oncologic outcomes.
RESULTS: After matching, 142 patients were included in each group. Obesity was associated with higher conversion rates to open surgery (2.8% versus 0%, p = 0.044) and increased overall complications (40.1% versus 28.9%, p = 0.046), driven mainly by surgical wound infections (9.2% versus 1.4%, p = 0.004). No differences were observed in major complications, anastomotic leakage, hospital stay, margin status, or 5-year overall (88% versus 89.4%, p = 0.409) and disease-free (62.7% versus 72.5%, p = 0.653) survival.
CONCLUSIONS: Obesity increased conversion and minor complication rates but did not adversely affect short-term outcomes or long-term oncologic outcomes after minimally invasive TME procedures. Tailored perioperative strategies may mitigate obesity-associated risks.
TRIAL REGISTRATION: Not applicable.
METHODS: Retrospective review of patients with rectal cancer undergoing laparoscopic, robotic, or transanal total mesorectal excision (TME) between January 2015 and December 2022. Propensity score matching (1:1) was performed on baseline characteristics. Primary outcomes included perioperative parameters, postoperative complications, and long-term oncologic outcomes.
RESULTS: After matching, 142 patients were included in each group. Obesity was associated with higher conversion rates to open surgery (2.8% versus 0%, p = 0.044) and increased overall complications (40.1% versus 28.9%, p = 0.046), driven mainly by surgical wound infections (9.2% versus 1.4%, p = 0.004). No differences were observed in major complications, anastomotic leakage, hospital stay, margin status, or 5-year overall (88% versus 89.4%, p = 0.409) and disease-free (62.7% versus 72.5%, p = 0.653) survival.
CONCLUSIONS: Obesity increased conversion and minor complication rates but did not adversely affect short-term outcomes or long-term oncologic outcomes after minimally invasive TME procedures. Tailored perioperative strategies may mitigate obesity-associated risks.
TRIAL REGISTRATION: Not applicable.