Tomoyuki Ueki, Hiromichi Sonoda, Toru Miyake, Tomoharu Shimizu, Masaji Tani. Shiga University of Medical Science
Background: It is considered that high visceral fat volume affects the technical difficulty in laparoscopic surgery. However, complex software image processing is required to calculate the visceral fat by using computerized tomography. To predict the amount of visceral fat more easily, we developed a practical technique by using “the perinephric fat thickness” measured on computerized tomography. In this study, we investigated the correlation between the perinephric fat thickness (PFT) and the conventional obesity parameters and the possibility that PFT could be a useful predictor of technical difficulty in laparoscopic colectomy.
Methods: We retrospectively reviewed 77 consecutive patients who received laparoscopic sigmoidectomy or high anterior resection for colorectal cancer between April 2014 and June 2018 in Shiga University of Medical Science hospital. We examined five obesity parameters as below, body mass index (BMI), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA: SFA+VFA), and PFT. Such parameters were calculated by using CT images scanned preoperatively. We used ‘‘AZE Virtual Place’’ to measure SFA, VFA and TFA on one cross-sectional scan obtained at the level of left renal vein. We defined PFT as the distance from the renal capsule to the sidewall in parallel to the left renal vein.
Results: The median age was 70 years old (38-91). 35 patients were male, and the other 42 patients were female. The tumor locations were described as below (Sigmoid : Rectosigmoid = 49 : 28). The median maximum tumor diameters were 34mm (10-90). The median BMI, SFA, VFA, TFA, and PFT were 21.7 (15.1-33.7), 82.4cm2 (15.5-236), 104cm2 (6.2-367.1), 193.7cm2 (23.5-603.2), and 12.6mm (1.77-29.4), respectively. The median operative time and the intraoperative blood loss were 201minutes (134-343) and 9g (0-450), respectively. Postoperative complications (Clavien-Dindo classification, > Grade 1) were occurred in 12 patients (15.6%). The median length of the postoperative hospital stay was 9days (7-40). BMI, SFA, VFA, and TFA had significant correlations with PFT (p=0.0003, 0.03, <0.0001, <0.0001). We divided patients into high and low groups in accordance with the median of each obesity parameters. The high groups of all obesity parameters: BMI, SFA, VFA, TFA and PFT required a significantly longer operative time than the low groups (p=0.014, 0.014, 0.023, 0.0003, 0.009). In two-way analysis of variance, only the high group of TFA tended to require a longer operative time (p=0.089).
Conclusion: PFT may be a simple and useful predictor comparable to VFA for assuming the technical difficulty of laparoscopic colectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92220
Program Number: P337
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster