World Journal of Surgery

, Volume 42, Issue 11, pp 3651–3657 | Cite as

Relationship Between Visceral Obesity and Postoperative Inflammatory Response Following Minimally Invasive Esophagectomy

  • Akihiko Okamura
  • Masayuki WatanabeEmail author
  • Ian Fukudome
  • Kotaro Yamashita
  • Masami Yuda
  • Masaru Hayami
  • Yu Imamura
  • Shinji Mine
Original Scientific Report



Esophagectomy for esophageal cancer is one of the most invasive surgeries. However, the factors influencing postoperative systemic inflammatory response following esophagectomy have not been elucidated. Recently, visceral fat has been shown to play an important role in both chronic and acute inflammation. In this study, we assessed the relationship between visceral obesity and postoperative inflammatory response following minimally invasive esophagectomy (MIE).


Visceral fat area (VFA) was measured using computed tomography in 152 patients undergoing MIE for esophageal cancer. We assessed perioperative serum C-reactive protein (CRP) levels preoperatively and on postoperative days (PODs) 1–5 and analyzed the relationship between VFA and perioperative serum CRP levels.


VFA was positively associated with preoperative serum CRP level (P < 0.001). Univariate analysis revealed that VFA was significantly associated with increased serum CRP levels on PODs 1–5 (P < 0.001 for each day), whereas multivariate analysis revealed that it was independently associated with increased serum CRP levels on PODs 1–4 (P = 0.033, 0.035, 0.001, and 0.006, respectively). Similar results were observed in patients who did not have postoperative infectious complications, such as pneumonia, anastomotic leak, and surgical site infection. VFA was not an independent risk factor for the occurrence of these postoperative infectious complications.


Visceral obesity might be associated with chronic inflammation in patients with esophageal cancer and promote postoperative inflammatory response following MIE.



This work was supported in part by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (Grant Number 15K10122).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
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Supplementary material 2 (DOCX 14 kb)
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Supplementary material 3 (DOCX 15 kb)
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Supplementary material 4 (DOCX 14 kb)
268_2018_4675_MOESM5_ESM.pptx (85 kb)
Relationships between VFA and other fat parameters. VFA was significantly associated with BMI (rs = 0.773; P < 0.001) as well as SFA (rs = 0.645; P < 0.001) (PPTX 84 kb)
268_2018_4675_MOESM6_ESM.pptx (51 kb)
Comparison of perioperative changes in serum CRP levels between patients with and without postoperative infectious complications. Patients with postoperative infectious complications had significantly higher levels of serum CRP on PODs 3–5 than those without postoperative infectious complications (*P < 0.05) (PPTX 51 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Akihiko Okamura
    • 1
  • Masayuki Watanabe
    • 1
    Email author
  • Ian Fukudome
    • 1
  • Kotaro Yamashita
    • 1
  • Masami Yuda
    • 1
  • Masaru Hayami
    • 1
  • Yu Imamura
    • 1
  • Shinji Mine
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterology CenterThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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