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Relationship between computed tomography-derived body composition, sex, and post-operative complications in patients with colorectal cancer

European Journal of Clinical Nutrition volume 73, pages 1450–1457 (2019)Cite this article

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Abstract

Introduction

In the UK, colorectal cancer is the fourth most common cancer and the second most common cause of cancer death. Surgery is the primary modality of treatment, but it is not without complications. Post-operative complications have been linked to preoperative of weight loss and loss of lean tissue, and also to obesity. Given sex differences in body composition, an examination of body composition and post-operative complications may provide valuable information. Therefore, the aim was to examine the relationship between male/female body composition and post-operative complications in patients with operable colorectal cancer.

Methods

Patients (n = 741) undergoing operation for colorectal cancer were examined. Preoperative CT scans were used to define the muscle mass and quality, visceral obesity, and subcutaneous adiposity. Post-operative complications, in particular, surgical site infection (SSI) and wound infection (WI) were considered as outcome measures.

Results

Male patients with greater subcutaneous adiposity had higher risk of SSI and WI (p < 0.01 and p ≤ 0.001, respectively). On multivariate analysis, Post-operative Glasgow Prognostic Score (poGPS) on Day 4 (OR 2.11, 95% CI 1.53–2.92, P = 0.001) laparoscopic surgery (OR 0.50, 95% CI 0.26–0.98, P = 0.044), and subcutaneous adiposity (OR 2.71, 95% CI 1.26–5.82, P = 0.011) remained significantly independently associated with overall SSI. Subcutaneous adiposity remained significantly independently associated with WI (OR 3.93, 95% CI 1.33–11.57, P = 0.013). In female patients, however, no significant association was found between any body composition measure and complications.

Conclusion

This study showed that increased subcutaneous and visceral adiposity were associated with infective complications in male, but not female patients, after colorectal cancer surgery. Therefore, it is important that sex be taken into account when evaluating the potential impact of body composition on post-operative outcomes in patients undergoing surgery for colorectal cancer.

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Acknowledgements

The authors acknowledge Douglas H Black for his assistance. Sources of Support (scholarship): King AbdulAziz university. Clinical nutrition department, Jeddah, Saudi Arabia. Clinical Trial Registry number: not applicable.

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Authors and Affiliations

  1. Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences, Royal Infirmary, University of Glasgow, Glasgow, G31 2ER, Scotland

    Arwa S. Almasaudi, Ross D. Dolan, Stephen T. McSorley, Paul G. Horgan & Donald C. McMillan

  2. Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, Glasgow Royal Infirmary, University of Glasgow, Glasgow, G31 2ER, Scotland

    Arwa S. Almasaudi & Christine Edwards

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  1. Arwa S. Almasaudi
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Contributions

ASA, DCM, and CE designed research; ASA, RDD, STM, and PGH collect the data; ASA and DCM analyzed data and interpretation; ASA wrote the paper; DCM and CE manuscript editing; and ASA, CE, and DCM had responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Arwa S. Almasaudi.

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Almasaudi, A.S., Dolan, R.D., McSorley, S.T. et al. Relationship between computed tomography-derived body composition, sex, and post-operative complications in patients with colorectal cancer. Eur J Clin Nutr 73, 1450–1457 (2019). https://doi.org/10.1038/s41430-019-0414-0

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