European Radiology

, Volume 29, Issue 3, pp 1240–1247 | Cite as

Quantitative assessment of mesorectal fat: new prognostic biomarker in patients with mid-to-lower rectal cancer

  • Jiyoung Yoon
  • Yong Eun ChungEmail author
  • Joon Seok Lim
  • Myeong-Jin Kim



To investigate the impact of mesorectal fat area (MFA) on oncologic outcomes in patients with mid-to-lower rectal cancer who received curative-intent surgery.


Patients with mid-to-lower rectal cancer who underwent preoperative abdominopelvic computed tomography (CT) and curative-intent surgery in 2011 were divided into two groups by tumour recurrence (group A) or no recurrence (group B) during a 5-year follow-up. Visceral fat area (VFA) and MFA were measured on preoperative CT and cutoff values were calculated using the Youden index. Univariate and multivariate regression analyses including BMI, VFA, and MFA were performed to investigate meaningful prognostic biomarkers. The Kaplan–Meier method with log-rank testing was used to validate prognostic biomarkers.


Group A contained 42 patients and group B had 155 patients. Cutoff values were 25 kg/m2 for BMI, 130 cm2 for VFA, and 10 cm2 for MFA using the Youden index. On multivariate Cox regression analysis, MFA (odds ratio [OR] = 0.426, p = 0.010), TNM stage (p = 0.027), and perioperative complication grade (p = 0.028) were significantly different between groups. BMI and VFA did not show significant differences. By the Kaplan–Meier method with log-rank testing, disease-free survival (DFS) was significantly longer in patients with MFA ≥10 cm2 compared to patients with MFA <10 cm2 (p = 0.021), with no significant difference in overall survival (OS).


MFA was an independent biomarker for predicting DFS in patients who underwent curative-intent surgery for mid-to-lower rectal cancer.

Key Points

Mesorectal fat area is associated with the prognosis of rectal cancer patients.

Mesorectal fat area can be calculated easily in pre-operative CT scan.

Predicting prognosis of the cancer patient before operation is important.


Intra-abdominal fat Body mass index Colorectal neoplasms Digestive system surgical procedures 



Abdominoperineal resection


American Society of Anesthesiologists


Body mass index


Chemoradiation therapy


Carcinoembryonic antigen


Disease free survival


Hounsfield units


Interspinous distance


Low anterior resection


Lymph node


Mesorectal fat area


Overall survival


Standard deviation


True conjugate


Total mesorectal excision


Ultralow anterior resection


Visceral fat area



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Myeong-Jin Kim, Severance Hospital.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yunho Rho, Yonsei University, College of Medicine, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5723_MOESM1_ESM.docx (82 kb)
ESM 1 (DOCX 81 kb)


  1. 1.
    American Institute for Cancer Research., World Cancer Research Fund (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective: a project of World Cancer Research Fund International. American Institute for Cancer Research, Washington, D.C.Google Scholar
  2. 2.
    Chen W, Li Q, Fan Y et al (2016) Factors Predicting Difficulty of Laparoscopic Low Anterior Resection for Rectal Cancer with Total Mesorectal Excision and Double Stapling Technique. PLoS One 11:e0151773CrossRefGoogle Scholar
  3. 3.
    Smith RK, Broach RB, Hedrick TL, Mahmoud NN, Paulson EC (2014) Impact of BMI on postoperative outcomes in patients undergoing proctectomy for rectal cancer: a national surgical quality improvement program analysis. Dis Colon Rectum 57:687–693CrossRefGoogle Scholar
  4. 4.
    Aytac E, Lavery IC, Kalady MF, Kiran RP (2013) Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum 56:689–697CrossRefGoogle Scholar
  5. 5.
    Doleman B, Mills KT, Lim S, Zelhart MD, Gagliardi G (2016) Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis. Tech Coloproctol 20:517–535CrossRefGoogle Scholar
  6. 6.
    Seishima R, Okabayashi K, Hasegawa H et al (2014) Obesity was associated with a decreased postoperative recurrence of rectal cancer in a Japanese population. Surg Today 44:2324–2331CrossRefGoogle Scholar
  7. 7.
    Bardou M, Barkun AN, Martel M (2013) Obesity and colorectal cancer. Gut 62:933–947CrossRefGoogle Scholar
  8. 8.
    Smith U (2015) Abdominal obesity: a marker of ectopic fat accumulation. J Clin Invest 125:1790–1792CrossRefGoogle Scholar
  9. 9.
    Singh S, Sharma AN, Murad MH et al (2013) Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 11:1399–1412 e1397CrossRefGoogle Scholar
  10. 10.
    Keum N, Lee DH, Kim R, Greenwood DC, Giovannucci EL (2015) Visceral adiposity and colorectal adenomas: dose-response meta-analysis of observational studies. Ann Oncol 26:1101–1109CrossRefGoogle Scholar
  11. 11.
    Cowey SL, Quast M, Belalcazar LM et al (2005) Abdominal obesity, insulin resistance, and colon carcinogenesis are increased in mutant mice lacking gastrin gene expression. Cancer 103:2643–2653CrossRefGoogle Scholar
  12. 12.
    Watanabe J, Tatsumi K, Ota M et al (2014) The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Colorectal Dis 29:343–351CrossRefGoogle Scholar
  13. 13.
    Tsujinaka S, Konishi F, Kawamura YJ et al (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1765 discussion 1765–1757CrossRefGoogle Scholar
  14. 14.
    Cakir H, Heus C, Verduin WM et al (2015) Visceral obesity, body mass index and risk of complications after colon cancer resection: A retrospective cohort study. Surgery 157:909–915CrossRefGoogle Scholar
  15. 15.
    Rickles AS, Iannuzzi JC, Mironov O et al (2013) Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg 17:133–143 discussion p.143CrossRefGoogle Scholar
  16. 16.
    Moon HG, Ju YT, Jeong CY et al (2008) Visceral Obesity May Affect Oncologic Outcome in Patients with Colorectal Cancer. Ann Surg Oncol 15:1918–1922CrossRefGoogle Scholar
  17. 17.
    Visser O, Bakx R, Zoetmulder FA et al (2007) The influence of total mesorectal excision on local recurrence and survival in rectal cancer patients: a population-based study in Greater Amsterdam. J Surg Oncol 95:447–454CrossRefGoogle Scholar
  18. 18.
    Boyle KM, Chalmers AG, Finan PJ, Sagar PM, Burke D (2009) Morphology of the mesorectum in patients with primary rectal cancer. Dis Colon Rectum 52:1122–1129CrossRefGoogle Scholar
  19. 19.
    Mazeh H, Samet Y, Abu-Wasel B et al (2009) Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg 208:355–361CrossRefGoogle Scholar
  20. 20.
    Billingsley CC, Cansino C, O'Malley DM et al (2016) Survival outcomes of obese patients in type II endometrial cancer: Defining the prognostic impact of increasing BMI. Gynecol Oncol 140:405–408CrossRefGoogle Scholar
  21. 21.
    Allen SD, Gada V, Blunt DM (2007) Variation of mesorectal volume with abdominal fat volume in patients with rectal carcinoma: assessment with MRI. Br J Radiol 80:242–247CrossRefGoogle Scholar
  22. 22.
    Sprenger T, Rothe H, Becker H et al (2013) Lymph node metastases in rectal cancer after preoperative radiochemotherapy: impact of intramesorectal distribution and residual micrometastatic involvement. Am J Surg Pathol 37:1283–1289CrossRefGoogle Scholar
  23. 23.
    Zheng YC, Tang YY, Zhou ZG et al (2004) Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner. World J Gastroenterol 10:3369–3373CrossRefGoogle Scholar
  24. 24.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701CrossRefGoogle Scholar
  25. 25.
    Maurer CA, Renzulli P, Kull C et al (2011) The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol 18:1899–1906CrossRefGoogle Scholar
  26. 26.
    Gollins S (2010) Radiation, chemotherapy and biological therapy in the curative treatment of locally advanced rectal cancer. Colorectal Dis 12(Suppl 2):2–24CrossRefGoogle Scholar
  27. 27.
    Dignam JJ, Polite BN, Yothers G et al (2006) Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 98:1647–1654CrossRefGoogle Scholar
  28. 28.
    Bertani E, Chiappa A, Della Vigna P et al (2014) The Impact of pelvimetry on anastomotic leakage in a consecutive series of open, laparoscopic and robotic low anterior resections with total mesorectal excision for rectal cancer. Hepatogastroenterology 61:1574–1581Google Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.BK21 PLUS Project for Medical ScienceYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations