Abstract:

Objective

To explore the effect of visceral fat area and sarcopenia on the surgical treatment and prognosis of patients with colorectal cancer.

Methods

The data of patients treated in Changshu No.2 People's Hospital from June 2017 to March 2019 were reviewed， and the patients meeting the inclusion and exclusion criteria were included one by one.A total of 120 patients with colorectal cancer were included， all of whom underwent abdominal CT examination， bioelectrical impedance analysis， muscle strength measurement， etc.According to the clinical examination results， they can be divided into four groups， one group was patients with simple colorectal cancer（36 cases， group A）， one group was patients with high visceral fat area（≥100 cm²） and colorectal cancer（30 cases， group B）， one group was patients with sarcopenia and colorectal cancer（30 cases， group C）， and one group was patients with high visceral fat area and sarcopenia and colorectal cancer （24 cases， group D）.The perioperative indicators and serum inflammatory factors of the four groups were compared.The influencing factors of prognosis were analyzed.

Results

There were no significant differences in postoperative body temperature， first postoperative exhaust time， indwelling catheter time and postoperative exhaust time among the four groups （P＞0.05）.Operation time and blood loss in group D were higher than those in group A （t=18.456， 22.984； P＜0.05）， group B （t=4.535，4.720； P＜0.05） and group C （t=3.383， 4.690； P＜0.05）.The operation time and blood loss of group B were higher than those of group A （t=3.109， 2.373； P＜0.05）， and the operation time and blood loss of group C were higher than those of group A （t=4.104， 2.055； P＜0.05）.The number of lymph node dissection in group D was lower than that in group A （t=9.992， P＜0.05）， group B （t=4.441， P＜0.05） and group C （t=3.567， P＜0.05），and the number of lymph node dissection in groups B and C was lower than that in group A （t=5.539， 6.527；P＜0.05）.The hospital stay of group D was longer than that of group A （t=7.130， P＜0.05）， group B （t=2.188，P＜0.05） and group C （t=2.063， P＜0.05）， and the hospital stay of group B and group C was longer than that of group A （t=5.866， 5.938； P＜0.05）.There was no significant difference in serum levels of inflammatory factors between the four groups before treatment （P＞0.05）.After surgical treatment， all the indexes of patients were increased， and the levels of white blood cell count， C-reactive protein and procalcitonin in group D were higher than those in group A （t=5.908， 14.862， 10.298； P＜0.05） and group B （t=2.947， 4.651， 5.799；P＜0.05）， group C （t=2.384， 3.711， 4.756； P＜0.05）； The indexes of group B were higher than those of group A（t=3.748， 5.114， 4.332； P＜0.05）.The indexes of group C were higher than those of group A （t=3.118， 6.292，6.154； P＜0.05）.The incidence of postoperative complications in group D was higher than that in group A（χ²=8.284， P＜0.05）.The survival rate of group A was 80.56% after 5 years of follow-up， and the difference was statistically significant （P＜0.05）.Univariate/multivariate Logistic regression analysis showed that within 95%CI， TNM stage Ⅲ， tumor size ＞ 5 cm， CEA value ＞ 5 μg/L， high visceral fat area （≥100 cm²） and sarcomia were independent risk factors for 5-year postoperative survival （OR value＞1）.

Conclusion

High visceral fat area and sarcopenia have corresponding effects on patients with colorectal cancer after operation，and the effect of patients with both is more significant， which can aggravate the postoperative inflammatory reaction， increase the incidence of complications， prolong the hospitalization time，and affect the long-term prognosis of patients.

Key words: Colorectal neoplasms, Visceral fat area, Muscle atrophy, Serum inflammatory factors, Complication, 5-year survival rate