Visceral obesity exacerbates perioperative muscle loss and impairs survival in colorectal cancer

Table 2 The relationship between skeletal muscle loss, visceral fat area, and clinical characteristics, mean ± SD/n (%)/median (interquartile range)

Feature	SML			VFA
	No (n = 272)	Yes (n = 117)	P value	Low (n = 175)	High (n = 214)	P value
Gender			0.801			0.062
Male	159 (58.46)	70 (59.83)		94 (53.71)	135 (63.08)
Female	113 (41.54)	47 (40.17)		81 (46.29)	79 (36.92)
Age			0.542			0.023
≤ 65	144 (52.94)	58 (49.57)		102 (58.29)	100 (46.73)
> 65	128 (47.06)	59 (50.43)		73 (41.71)	114 (53.27)
BMI (kg/m2)	22.74 ± 3.11	22.92 ± 3.30	0.623	21.34 ± 2.90	24.00 ± 2.87	0.000
Cardiovascular disease			0.905			0.001
None	196 (72.06)	85 (72.65)		141 (80.57)	140 (65.42)
Yes	76 (27.94)	32 (27.35)		34 (19.43)	74 (34.58)
Respiratory disease			0.811			0.835
None	218 (80.15)	95 (81.20)		140 (80.00)	173 (80.84)
Yes	54 (19.85)	22 (18.80)		35 (20.00)	41 (19.16)
Diabetes			0.943			0.000
None	224 (82.35)	96 (82.05)		158 (90.29)	162 (75.70)
Yes	48 (17.65)	21 (17.95)		17 (9.71)	52 (24.30)
VFA (cm2)	99.45 (66.08-143.54)	134.0 (81.30-174.40)	0.001	66.27 (44.26-85.52)	148.965 (126.16-181.58)	0.000
Preoperative SMI (cm2/m2)	42.79 (37.7-47.2)	45.09 (40.7-51.3)	0.004	40.56 (36.11-45.60)	45.035 (41.47-50.27)	0.000
Preoperative Sarcopenia			0.026			0.006
Yes	179 (65.81)	63 (53.85)		122 (69.71)	120 (56.08)
No	93 (34.19)	54 (46.15)		53 (30.29)	94 (43.93)
Postoperative SMI (cm2/m2)	45.41 (40.4-50.1)	39.92 (35.0-45.4)	0.000	42.45 (37.21-47.66)	45.20 (40.06-49.65)	0.001
ΔSMI (%)	0.04 (0.00-0.11)	-0.10 (-0.15 to -0.08)	0.000	0.03 (-0.04 to 0.10)	-0.01 (-0.09 to 0.06)	0.001
VSR (%, cm2/m2)	2.524 ± 1.295	2.898 ± 1.465	0.012	1.53 (1.02-1.95)	3.25 (2.77-4.04)	0.000
Preoperative albumin (g/L)	41.60 (37.4-44.7)	42.70 (38.7-45.7)	0.047	42.30 (37.70-45.10)	41.50 (37.38-44.83)	0.308
Serum total protein (g/L)	69.38 ± 7.62	70.34 ± 6.58	0.236	70.40 (65.40-75.40)	69.95 (64.325-74.70)	0.476
Globulin level (g/L)	28.250 (24.8-31.5)	28.30 (25.6-31.2)	0.798	28.40 (24.80-31.00)	28.20 (25.08-31.70)	0.875
Hemoglobin (g/L)	126.50 (105.0-140.0)	130.00 (105.0-142.0)	0.565	126.00 (105.00-140.00)	128.50 (104.75-140.00)	0.962
Platelet (× 109/L)	216.50 (167.3-278.8)	204.00 (151.5-251.5)	0.065	215.00 (168.00-277.00)	210.00 (159.25-262.25)	0.59
Neutrophil count (× 109/L)	4.43 (3.3-5.9)	4.20 (3.2-5.6)	0.234	4.40 (3.370-5.40)	4.35 (3.192-5.92)	0.687
Lymphocyte count (× 109/L)	1.380 (1.0-1.8)	1.40 (1.0-1.8)	0.686	1.34 (1.00-1.75)	1.42 (1.07-1.79)	0.161
Tumor site			0.923			0.818
Sigmoid colon	30 (11.03)	13 (11.11)		18 (10.29)	25 (11.68)
Rectum	67 (24.63)	28 (23.93)		45 (25.71)	50 (23.36)
Colon	175 (64.34)	76 (64.96)		112 (64.00)	139 (64.95)
Differentiation degree			0.24			0.84
Low	59 (21.69)	31 (26.50)		39 (22.29)	51 (23.83)
Medium	191 (70.22)	79 (67.52)		124 (70.86)	146 (68.22)
High	22 (8.09)	7 (5.98)		12 (6.86)	17 (7.94)
Vascular nerve invasion			0.206			0.091
None	172 (63.24)	66 (56.41)		99 (56.57)	139 (64.95)
Yes	100 (36.76)	51 (43.59)		76 (43.43)	75 (35.05)
Pathological grade (pTNM)			0.096			0.063
Stage I	33 (12.13)	13 (11.11)		19 (10.86)	27 (12.62)
Stage II	139 (51.10)	49 (41.88)		96 (54.86)	92 (42.99)
Stage III	100 (36.76)	55 (47.01)		60 (34.29)	95 (44.39)
Postoperative adjuvant chemotherapy			0.589			0.003
None	100 (36.76)	55 (47.01)		79 (45.14)	129 (60.28)
Yes	129 (47.43)	52 (44.44)		96 (54.86)	85 (39.72)
Surgical approach			0.36			0.260
Open	137 (50.37)	53 (45.30)		91 (52.00)	99 (46.26)
Laparoscopic	135 (49.63)	64 (54.70)		84 (48.00)	115 (53.74)
Prophylactic ileostomy status			0.047			0.598
None	231 (85.24)	90 (76.92)		142 (81.61)	179 (83.65)
Yes	40 (14.76)	27 (23.08)		32 (18.39)	35 (16.36)
Intraoperative blood loss (mL)	100.00 (50.00-100.00)	100.00 (50.00-100.00)	0.569			0.947
Operation time (minutes)	200.00 (165.00-240.00)	205.00 (165.00-257.50)	0.735	91 (52.00)	112 (52.34)
ASA classification			0.815	84 (48.00)	102 (47.66)
< III	143 (52.57)	60 (51.28)		80.0 (50.0-100.0)	100.0 (50.0-150.00)	0.001
≥ III	129 (47.43)	57 (48.72)		200 (165.0-245.0)	204. (165.00-245.25)	0.452
LOS (days)	15.00 (13.00-19.00)	15.00 (13.00-20.00)	0.356	14.0 (13.0-18.0)	16.0 (13.0-20.0)	0.001
Number of lymph nodes dissected (n)	10.00 (5.00-14.00)	10.00 (6.00-13.00)	0.677	10.00 (6.0-14.0)	10.00 (5.0-14.0)	0.495
FPT (days)	3.00 (2.00-3.00)	3.00 (2.00-3.00)	0.782	3.00 (2.00-4.00)	3.00 (2.00-3.00)	0.199
Complications			0.613			0.757
None	202 (74.26)	84 (71.79)		130 (74.29)	156 (72.90)
Yes	70 (25.74)	33 (28.21)		45 (25.71)	58 (27.10)
Postoperative infectious complications			0.721			0.427
No	207 (76.10)	91 (77.78)		164 (93.71)	196 (91.59)
Yes	65 (23.90)	26 (22.22)		11 (6.29)	18 (8.41)
Postoperative non-infectious complications			0.338			0.798
No	254 (93.38)	106 (90.60)		133 (76.00)	165 (77.10)
Yes	18 (6.62)	11 (9.40)		42 (24.00)	49 (22.90)

This table illustrates the association between skeletal muscle loss and visceral fat area groupings and the preoperative clinical indicators as well as short-term outcomes in patients with colorectal cancer. BMI: Body mass index; VFA: Visceral fat area; VSR: Visceral-to-skeletal muscle ratio; SMI: Skeletal muscle index; SML: Skeletal muscle loss; ASA: American Society of Anesthesiologist; pTMN: Pathologic tumor-node-metastasis; LOS: Length of hospital stay; FPT: Flatus passage time.