Visceral obesity, smoking, and multimorbidity predict adverse short-term outcomes following exenterative rectal cancer surgery: A contemporary tertiary centre cohort.

INTRODUCTION

Beyond total mesorectal excision (bTME) and pelvic exenteration (PE) represent the only potentially curative option for locally advanced (LARC) and locally recurrent rectal cancer (LRRC) but are associated with substantial morbidity. The predictive value of host factors, including computed tomography-body composition measurements (CT-BCM), remains unclear. This study evaluated whether CT-BCM and other host factors independently predict major complications and reoperation after exenterative rectal cancer surgery.

METHODS

A retrospective cohort study was conducted of patients undergoing bTME or PE for LARC or LRRC at a tertiary centre between 2015 and 2022. Clinical, pathological, operative, and CT-BCM variables were evaluated. Primary outcomes were major complications (Clavien-Dindo ≥ III) and reoperation within 30 days. Multivariable Firth penalised logistic regression models were fitted.

RESULTS

In total, 134 patients were included (median age 61 years; 56% male); 82% had LARC and 50% underwent PE. Overall, 57% were high-complexity, and the R0 resection rate was 79%. Major complications occurred in 31 patients (23%), while 17 (13%) underwent reoperation. Visceral obesity (adjusted OR 5.39, 95% CI 1.53-28.6; p = 0.007) and current smoking (adjusted OR 4.61, 95% CI 1.15-19.4; p = 0.032) independently predicted reoperation. Charlson Comorbidity Index (CCI) ≥6 (adjusted OR 2.80, 95% CI 1.15-6.98; p = 0.024), current smoking (adjusted OR 3.42, 95% CI 1.13-10.6; p = 0.030) and former smoking (adjusted OR 3.48, 95% CI 1.33-9.43; p = 0.011) independently predicted major complications.

CONCLUSION

Visceral obesity and current smoking independently predicted reoperation, while multimorbidity and both current and former smoking independently predicted major complications. These findings may inform preoperative risk stratification and optimisation.