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Visceral obesity enhances inflammatory response after laparoscopic colorectal resection
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  • Cristian Conti,
  • Corrado Pedrazzani,
  • Giulia Turri,
  • Gabriele Gecchele,
  • Alessandro Valdegamberi,
  • Andrea Ruzzenente,
  • Giulia Zamboni,
  • Giuseppe Lippi,
  • Alfredo Guglielmi
Cristian Conti
University of Verona
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Corrado Pedrazzani
University of Verona
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Giulia Turri
University of Verona
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Gabriele Gecchele
University of Verona
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Alessandro Valdegamberi
University of Verona
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Andrea Ruzzenente
University of Verona
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Giulia Zamboni
University of Verona
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Giuseppe Lippi
University of Verona
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Alfredo Guglielmi
University of Verona
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Abstract

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.

Peer review status:ACCEPTED

05 Jul 2021Submitted to International Journal of Clinical Practice
08 Jul 2021Submission Checks Completed
08 Jul 2021Assigned to Editor
08 Jul 2021Reviewer(s) Assigned
16 Jul 2021Review(s) Completed, Editorial Evaluation Pending
20 Jul 2021Editorial Decision: Revise Major
26 Jul 20211st Revision Received
27 Jul 2021Assigned to Editor
27 Jul 2021Submission Checks Completed
27 Jul 2021Review(s) Completed, Editorial Evaluation Pending
28 Jul 2021Reviewer(s) Assigned
03 Aug 2021Editorial Decision: Revise Minor
03 Aug 20212nd Revision Received
04 Aug 2021Submission Checks Completed
04 Aug 2021Review(s) Completed, Editorial Evaluation Pending
04 Aug 2021Assigned to Editor
04 Aug 2021Reviewer(s) Assigned
06 Aug 2021Editorial Decision: Revise Minor
07 Aug 20213rd Revision Received
09 Aug 2021Assigned to Editor
09 Aug 2021Submission Checks Completed
09 Aug 2021Review(s) Completed, Editorial Evaluation Pending
25 Aug 2021Editorial Decision: Revise Major
27 Aug 20214th Revision Received
28 Aug 2021Assigned to Editor
28 Aug 2021Review(s) Completed, Editorial Evaluation Pending
28 Aug 2021Submission Checks Completed
02 Sep 2021Editorial Decision: Accept