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Impact of obesity on postoperative complications in colorectal cancer surgery: A systematic review and meta-analysis
Journal
Seminars in Cancer Biology
ISSN
10963650
Date Issued
2025-08
Author(s)
Sarno, Gerardo
Gargiulo, Antonio
University of Naples Federico II
Anna Tedesco
Iacone, Biancamaria
Claudia Reytor-González
Jaime Angamarca Iguago
Sarno, Sabrina
Istituto Nazionale Tumori IRCCS Fondazione Pascale, Università degli Studi della Campania Luigi Vanvitelli
Frias-toral Evelyn
American Heart Association, American Heart Association Inc, American Society for Parenteral and Enteral Nutrition, Asociación Ecuatoriana de Nutrición Enteral y Parenteral, COLOMBIAN JOURNAL FOR CLINICAL NUTRITION AND METABOLISM (RCNC), Clarivate (United States), Edizioni Minerva Medica, Escuela Superior Politécnica del Litoral, Escuela Superior Politécnica del Litoral Escuela de Posgrado en Administración de Empresas, European Journal of Clinical Nutrition, European Society for Clinical Nutrition and Metabolism, European Society for Medical Oncology, Frontiers in Endocrinology, Frontiers in Nutriton, Fundación Rostros Felices, Hospital General Luis Vernaza, Hospital de Niños Doctor Roberto Gilbert Elizalde, Instituto Oncológico Nacional Dr Juan Tanca Marengo, Instituto de Promoción de Exportaciones e Inversiones PRO Ecuador, International Society Burns Injuries, LATINO AMERICAN FEDERATION FOR CLINICAL NUTRITION AND METABOLISM (FELANPE), National Healthcare Association, RED DE REVISTAS MÉDICAS ECUATORIANAS (REVIMEC), Secretaría de Educación Superior, Ciencia, Tecnología e Innovación, Sociedad Ecuatoriana de Oncología, Society for the Advancement of Blood Management, Society for the Advancement of Patient Blood Management, Taylor and Francis (United Kingdom), Texas State University, UNIVERSIDAD MONTRER, Universidad Católica Santiago de Guayaquil, Universidad Católica de Santiago de Guayaquil, Universidad Católica de Santiago de Guayaquil Facultad de Ciencias Médicas, Universidad de Especialidades Espíritu Santo, Universidad de Guayaquil, University of Michigan
Bracale, Umberto
Federico II University Hospital, UNIVERSITA' DEGLI STUDI DI SALERNO, Università degli Studi di Salerno
Abstract
Background
Obesity has been increasingly recognized as a factor that influences postoperative outcomes in colorectal cancer surgery. However, its impact on surgical complications, mortality, and oncological outcomes remains controversial. This systematic review and meta-analysis aimed to evaluate the association between obesity and postoperative complications in colorectal cancer surgery.
Methods
A comprehensive search was conducted in MEDLINE/PubMed, Scopus, and Embase, including studies evaluating body mass index (BMI) in relation to postoperative complications such as infections, anastomotic leakage, postoperative ileus, bleeding, reoperation, and mortality. Data synthesis involved a qualitative analysis of all eligible studies and a meta-analysis when applicable. The quality of the studies included was assessed using the Newcastle-Ottawa Scale, while the certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Results
Twenty-nine studies were included in the qualitative analysis and 17 were eligible for the meta-analysis. Compared to BMI < 30 kg/m², patients with BMI ≥ 30 kg/m² showed significantly higher risk of any type of surgical site infection (OR=1.49; 95 % CI: 1.37–1.70; low certainty). No significant differences were found in mortality (OR=1.23; 95 % CI: 0.72–2.11; very low certainty), hemorrhage (OR=1.05; 95 % CI: 0.97–1.14; very low certainty), or gastrointestinal complications (OR=1.10; 95 % CI: 0.96–1.26; very low certainty).
Conclusion
Obesity significantly increases the risk of surgical site infections in colorectal cancer surgery. Although its impact on mortality and gastrointestinal complications remains unclear, implementing preoperative optimization protocols specifically aimed at obesity management could mitigate these surgical risks. The certainty of evidence ranges from low to very low, highlighting the need for high-quality prospective studies with standardized BMI criteria and surgical protocols.
Obesity has been increasingly recognized as a factor that influences postoperative outcomes in colorectal cancer surgery. However, its impact on surgical complications, mortality, and oncological outcomes remains controversial. This systematic review and meta-analysis aimed to evaluate the association between obesity and postoperative complications in colorectal cancer surgery.
Methods
A comprehensive search was conducted in MEDLINE/PubMed, Scopus, and Embase, including studies evaluating body mass index (BMI) in relation to postoperative complications such as infections, anastomotic leakage, postoperative ileus, bleeding, reoperation, and mortality. Data synthesis involved a qualitative analysis of all eligible studies and a meta-analysis when applicable. The quality of the studies included was assessed using the Newcastle-Ottawa Scale, while the certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Results
Twenty-nine studies were included in the qualitative analysis and 17 were eligible for the meta-analysis. Compared to BMI < 30 kg/m², patients with BMI ≥ 30 kg/m² showed significantly higher risk of any type of surgical site infection (OR=1.49; 95 % CI: 1.37–1.70; low certainty). No significant differences were found in mortality (OR=1.23; 95 % CI: 0.72–2.11; very low certainty), hemorrhage (OR=1.05; 95 % CI: 0.97–1.14; very low certainty), or gastrointestinal complications (OR=1.10; 95 % CI: 0.96–1.26; very low certainty).
Conclusion
Obesity significantly increases the risk of surgical site infections in colorectal cancer surgery. Although its impact on mortality and gastrointestinal complications remains unclear, implementing preoperative optimization protocols specifically aimed at obesity management could mitigate these surgical risks. The certainty of evidence ranges from low to very low, highlighting the need for high-quality prospective studies with standardized BMI criteria and surgical protocols.