Predictive value of visceral obesity for postoperative infection complications in patients undergoing radical resection of colorectal cancer

doi:10.3877/cma.j.issn.2095-2015.2025.03.002

Abstract

Abstract:

Objective

To investigate the predictive value of visceral obesity (VO) for postoperative infection complications in patients undergoing radical resection of colorectal cancer.

Methods

A total of 132 patients who undergoing radical resection of colorectal cancer in Lishui Branch of Zhongda Hospital, Southeast University from July 2021 to February 2023 were retrospectively analyzed.According to whether the patients were diagnosed with VO [visceral fat area (VFA) ≥80 cm² on CT], the patients were divided into VO group and non-VO group, including 69 and 63 patients, respectively.Demographic characteristics, comorbidities, preoperative biochemical data, tumor pathological features,perioperative conditions, and postoperative infection complications were collected.Postoperative infectious complications were defined as any infection that occurs during a patient's hospital stay, including both surgical and non-surgical site infections.Logistic regression analysis was used to find the influencing factors of postoperative infectious complications in patients with radical resection of colorectal cancer.ROC curve was drawn to analyze the clinical value of VFA and body mass index (BMI) in predicting postoperative infectious complications in patients undergoing radical resection of colorectal cancer.

Results

The incidence of postoperative infectious complications in VO group was significantly higher than that in non-VO group (P<0.05).Multivariate logistic regression results showed that smoking(OR=4.994, 95% CI 1.517-16.442, P=0.008), fasting blood glucose (increase of 1 mmol/L, OR=4.121, 95%CI 1.791-9.480, P<0.001), operation time>4 h (OR=4.462, 95% CI 1.410-14.117, P=0.011), VO (OR=3.532,95% CI 1.083-11.513, P=0.036) was risk factors for postoperative infectious complications in patients with radical resection of colorectal cancer.ROC curve results showed that the area under the curve (AUC) of VFA in predicting postoperative infectious complications in patients undergoing radical resection of colorectal cancer was 0.708, which was higher than that of BMI (0.606).

Conclusion

VO is a risk factor for postoperative infectious complications in patients undergoing radical resection of colorectal cancer.Compared with BMI, VFA exhibits higher sensitivity in predicting postoperative infectious complications in patients undergoing radical resection for colorectal cancer.However, the current study do not demonstrate a significant advantage in overall predictive ability, and further research is needed to validate these findings.

Key words: Colorectal cancer, Visceral obesity, Visceral fat area, Radical operation, Postoperative infection

Min Hong, Jianfeng Xu, Chen Feng. Predictive value of visceral obesity for postoperative infection complications in patients undergoing radical resection of colorectal cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 199-204.

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Figures/Tables 4

临床资料	内脏型肥胖组(n=69)	非内脏型肥胖组(n=63)	t值/χ²值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	67.7±6.8	67.4±5.6	0.247	0.805
性别[例(%)]			0.732	0.392
男	31(44.9)	33(52.4)
女	38(55.1)	30(47.6)
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	23.5±2.0	22.8±1.7	2.083	0.039
吸烟[例(%)]	18(26.1)	15(23.8)	0.091	0.763
合并症[例(%)]
糖尿病	18(26.1)	18(28.6)	0.102	0.749
高血压	30(43.5)	25(39.7)	0.195	0.659
慢性阻塞性肺疾病	6(8.7)	5(7.9)	0.025	0.875
冠心病	8(11.6)	10(15.9)	0.512	0.474
术前血清白蛋白(g/L, $\overset{ˉ}{x}$ ± s )	43.2±5.0	42.1±5.2	1.221	0.224
术前血红蛋白(g/L, $\overset{ˉ}{x}$ ± s )	126.1±13.1	124.2±14.4	0.828	0.409
术前空腹血糖(mmol/L, $\overset{ˉ}{x}$ ± s )	5.1±0.8	5.0±0.7	0.116	0.908
肿瘤最大直径(cm, $\overset{ˉ}{x}$ ± s )	4.1±1.0	4.2±0.9	0.360	0.719
肿瘤位置			0.106	0.745
结肠[例(%)]	32(46.4)	31(49.2)
直肠[例(%)]	37(53.6)	32(50.8)
分化程度			0.929	0.335
低分化[例(%)]	18(26.1)	12(19.0)
中、高分化[例(%)]	51(73.9)	51(81.0)
TNM 分期			0.127	0.721
＜Ⅱ b 级[例(%)]	35(50.7)	30(47.6)
≥Ⅱ b 级[例(%)]	34(49.3)	33(52.4)
术中输血[例(%)]	7(10.1)	9(14.3)	0.530	0.467
手术时间			0.038	0.846
＞4 h[例(%)]	23(33.3)	20(31.7)
≤4 h[例(%)]	46(66.7)	43(68.3)
手术入路			-	0.747
腔镜手术[例(%)]	63(91.3)	59(93.7)
开腹手术[例(%)]	6(8.7)	4(6.3)
造瘘[例(%)]	21(30.4)	17(27.0)	0.191	0.662
术后感染并发症[例(%)]	19(27.5)	8(12.7)	4.456	0.035
手术部位感染	10(14.5)	2(3.2)	5.104	0.024
非手术部位感染	9(13.0)	6(9.5)	0.405	0.525
术后入ICU 人数[例(%)]	9(13.0)	3(4.8)	2.273	0.098

临床资料	内脏型肥胖组(n=69)	非内脏型肥胖组(n=63)	t值/χ²值	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	67.7±6.8	67.4±5.6	0.247	0.805
性别[例(%)]			0.732	0.392
男	31(44.9)	33(52.4)
女	38(55.1)	30(47.6)
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	23.5±2.0	22.8±1.7	2.083	0.039
吸烟[例(%)]	18(26.1)	15(23.8)	0.091	0.763
合并症[例(%)]
糖尿病	18(26.1)	18(28.6)	0.102	0.749
高血压	30(43.5)	25(39.7)	0.195	0.659
慢性阻塞性肺疾病	6(8.7)	5(7.9)	0.025	0.875
冠心病	8(11.6)	10(15.9)	0.512	0.474
术前血清白蛋白(g/L, $\overset{ˉ}{x}$ ± s )	43.2±5.0	42.1±5.2	1.221	0.224
术前血红蛋白(g/L, $\overset{ˉ}{x}$ ± s )	126.1±13.1	124.2±14.4	0.828	0.409
术前空腹血糖(mmol/L, $\overset{ˉ}{x}$ ± s )	5.1±0.8	5.0±0.7	0.116	0.908
肿瘤最大直径(cm, $\overset{ˉ}{x}$ ± s )	4.1±1.0	4.2±0.9	0.360	0.719
肿瘤位置			0.106	0.745
结肠[例(%)]	32(46.4)	31(49.2)
直肠[例(%)]	37(53.6)	32(50.8)
分化程度			0.929	0.335
低分化[例(%)]	18(26.1)	12(19.0)
中、高分化[例(%)]	51(73.9)	51(81.0)
TNM 分期			0.127	0.721
＜Ⅱ b 级[例(%)]	35(50.7)	30(47.6)
≥Ⅱ b 级[例(%)]	34(49.3)	33(52.4)
术中输血[例(%)]	7(10.1)	9(14.3)	0.530	0.467
手术时间			0.038	0.846
＞4 h[例(%)]	23(33.3)	20(31.7)
≤4 h[例(%)]	46(66.7)	43(68.3)
手术入路			-	0.747
腔镜手术[例(%)]	63(91.3)	59(93.7)
开腹手术[例(%)]	6(8.7)	4(6.3)
造瘘[例(%)]	21(30.4)	17(27.0)	0.191	0.662
术后感染并发症[例(%)]	19(27.5)	8(12.7)	4.456	0.035
手术部位感染	10(14.5)	2(3.2)	5.104	0.024
非手术部位感染	9(13.0)	6(9.5)	0.405	0.525
术后入ICU 人数[例(%)]	9(13.0)	3(4.8)	2.273	0.098

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.030	0.034	0.811	0.970	0.908～1.037	0.368
性别
男	0.204	0.434	0.221	1.226	0.524～2.870	0.638
女				参考值
体重指数	0.222	0.119	3.469	1.249	0.988～1.578	0.063
吸烟	1.373	0.458	8.969	3.946	1.607～9.691	0.003
糖尿病	0.581	0.458	1.606	1.787	0.728～4.388	0.205
高血压	-0.243	0.445	0.299	0.784	0.328～1.875	0.585
慢性阻塞性肺疾病	0.416	0.714	0.339	1.516	0.374～6.147	0.560
冠心病	0.475	0.577	0.678	1.608	0.519～4.986	0.410
血清白蛋白	0.003	0.043	0.005	1.003	0.922～1.090	0.945
血红蛋白	0.024	0.017	1.982	1.025	0.990～1.060	0.159
空腹血糖	1.430	0.360	15.762	4.178	2.063～8.464	＜0.001
最大直径	-0.377	0.234	2.591	0.686	0.434～1.085	0.107
位置
结肠	-0.021	0.432	0.002	0.979	0.420～2.283	0.961
直肠				参考值
分化程度
低分化	0.463	0.485	0.911	0.630	0.243～1.628	0.340
中、高分化				参考值
TNM 分期
＜Ⅱ b 级	-0.508	0.438	1.348	0.602	0.255～1.419	0.246
≥Ⅱ b 级				参考值
输血	0.298	0.623	0.230	1.348	0.398～4.566	0.632
手术时间
＞4 h	1.436	0.451	10.139	4.202	1.737～10.168	0.001
≤4 h				参考值
手术入路
腔镜	-0.030	0.822	0.001	0.970	0.194～4.856	0.970
开腹				参考值
造瘘	1.494	0.454	10.858	4.457	1.832～10.840	＜0.001
内脏型肥胖
是	0.960	0.465	4.273	2.612	1.051～6.494	0.039
否				参考值

影响因素	B	SE	Wald	OR	95% CI	P值
年龄	-0.082	0.046	3.265	0.921	0.842～1.007	0.071
体重指数	0.132	0.148	0.798	1.141	0.854～1.524	0.372
吸烟	1.608	0.608	6.998	4.994	1.517～16.442	0.008
空腹血糖	1.416	0.425	11.099	4.121	1.791～9.480	＜0.001
手术时间
＞4 h	1.496	0.588	6.477	4.462	1.410～14.117	0.011
≤4 h				参考值
造瘘	0.765	0.572	1.785	2.149	0.700～6.599	0.181
内脏型肥胖
是	1.262	0.603	4.380	3.532	1.083～11.513	0.036
否				参考值

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