Visceral obesity enhances inflammatory response after laparoscopic
Aims: C-reactive protein (CRP) is commonly used for monitoring Surgical
Stress Response (SSR) and detecting post-operative infectious
complications. However, high CRP values can be associated to
patient-related factors independently from complications. The aim of
this study was to assess the relationship between visceral obesity (VO)
and SSR after laparoscopic colorectal resection. Methods: Visceral
adipose tissue (VAT) area was measured at CT images for 357 patients who
underwent elective laparoscopic colorectal resection at our institution.
Post-operative outcomes and CRP values were compared between VO and
non-VO groups, defined according to VAT cut-offs. Univariate and
multivariate analyses were conducted for factors affecting SSR. ROC
curves were constructed to assess the most appropriate CRP values for
identifying infectious complications in the VO and non-VO populations.
Results: In the final cohort, 62.2% of patients were classified as VO.
No differences were seen in post-operative outcomes and infectious
complications. VO was associated with higher CRP values on
post-operative day (POD)1, POD2, POD3, and POD5, considering both the
overall cohort and patients without infectious complications. A positive
correlation was found between VAT and CRP values on all PODs, and VO
independently predicted increased CRP on POD1-3 in patients without
infectious complications but not in those who developed complications.
ROC curves analysis for POD3 CRP showed comparable accuracy for
detection of infectious complications in both groups, though the optimal
cut-off value was higher in VO group (154 vs. 136 mg/dl). Conclusions:
Although VO is not associated to increased complications after
laparoscopic colorectal resection, it independently predicts increased
SSR risk. To achieve accurate identification of infectious
complications, different cut-off values of POD3 CRP shall be used in VO
and non-VO patients.