Background: The influence of obesity on surgical outcomes after laparoscopic colorectal surgery in Asian patients is unclear. The aim of this study was to evaluate the feasibility and safety of laparoscopic surgery in obese Asian patients with colorectal cancer.
Methods: We retrospectively reviewed the prospectively collected data on 984 consecutive patients who underwent laparoscopic surgery for colorectal cancer between May 2001 and February 2008. Patients were classified according to the categories proposed by the International Obesity Task Force, as Nonobese (body mass index [BMI] < 25.0 kg/m(2)), Obese I (BMI 25.0-29.9 kg/m(2)), and Obese II (BMI > or = 30 kg/m(2)). Surgical outcomes, including open conversion, operation time, postoperative complications, estimated blood loss, and postoperative hospital stay, were compared in Nonobese, Obese I, and Obese II patients.
Results: Of the 984 patients, 645 (65.5%), 312 (31.7%), and 27 (2.7%), were classified as Nonobese, Obese I, and Obese II, respectively. Clinicopathologic characteristics were similar among the three groups. The Obese II group had higher conversion rates (14.8% versus 2.6% and 2.9%, P = 0.001), longer operation time (258 versus 201 and 215 min, P = 0.001), and longer postoperative hospital stay (12.1 versus 9.5 and 9.2 days, P = 0.035) than the Nonobese and Obese I groups. However, the rates of intraoperative events (P = 0.634) and postoperative complications (P = 0.603) were similar in nonobese and obese patients. Independent risk factors for conversion were BMI group and operation type. Obese II patients had an 8.36-fold greater risk of conversion than had Nonobese patients (P = 0.001).
Conclusions: With sufficient experience, laparoscopic colorectal surgery in obese Asian patients is feasible and safe, offering all the benefits of a minimally invasive approach. Management of Asian colorectal cancer patients with BMI > or = 30 kg/m(2) requires meticulous perioperative care, and colorectal surgeons must be familiar with obesity-related challenges in such patients.