International Journal of Colorectal Disease

, Volume 33, Issue 9, pp 1303–1307 | Cite as

Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers

  • Kang Hong Lee
  • Bo-kyeong Kang
  • Byung Kyu AhnEmail author
Short Communication



Obesity is thought to influence postoperative complications and recurrence of mid and low rectal cancer (MLRC) because of intraoperative technical difficulties. However, few reports have described the relationship between obesity indices and the clinical outcomes of MLRC. This study aimed to investigate the association between visceral obesity on computed tomography (CT) and oncolofical outcomes after surgery for MLRC and identify the obesity index that most accurately reflects clinical outcomes.


We investigated 125 patients who underwent curative resection for MLRC between 2004 and 2010. Visceral fat area (VFA) was defined as the umbilicus-level intra-abdominal adipose tissue area measured by CT. Body mass index (BMI), total fat area, VFA, subcutaneous fat area (SFA) and VFA/SFA ratio (V/S ratio) were analysed.


The median follow-up time was 60.3 months (range, 38.2–122.6 months). Recurrence was detected in 28 (22.4%) patients. Among the various obesity indices, recurrence was significantly associated with V/S ratio only (1.02 ± 0.45 versus 0.86 ± 0.34; P = 0.046). Stage, preoperative carcinoembryonic antigen level, V/S ratio, lymphatic invasion and perineural invasion were significantly associated with recurrence on univariate analysis, while only V/S ratio (P = 0.019; 95% confidence interval, 1.22 to 9.09) was significantly associated with recurrence on multivariate analysis. Disease-free and overall survival of the obese group (V/S ratio > 1.0) were shorter than those of the non-obese group.


V/S ratio is the optimal obesity index for predicting stage I–III MLRC recurrence.


Rectal cancer Visceral Obesity Visceral fat area/subcutaneous fat area ratio 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ballian N, Yamane B, Leverson G, Harms B, Heise CP, Foley EF, Kennedy GD (2010) Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma. Ann Surg Oncol 17:1606–1613CrossRefPubMedGoogle Scholar
  2. 2.
    Clark W, Siegel EM, Chen YA, Zhao X, Parsons CM, Hernandez JM, Weber J, Thareja S, Choi J, Shibata D (2013) Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation. J Am Coll Surg 216:1070–1081CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB, Macdonald JS, Fuchs CS (2003) Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 98:484–495CrossRefPubMedGoogle Scholar
  4. 4.
    Meyerhardt JA, Tepper JE, Niedzwiecki D, Hollis DR, McCollum AD, Brady D, O’Connell MJ, Mayer RJ, Cummings B, Willett C, Macdonald JS, Benson AB III, Fuchs CS (2004) Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol 22:648–657CrossRefPubMedGoogle Scholar
  5. 5.
    Sinicrope FA, Foster NR, Sargent DJ, O’Connell MJ, Rankin C (2010) Obesity is an independent prognostic variable in colon cancer survivors. Clin Cancer Res 16:1884–1893CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bouchard C, Despres JP, Mauriege P (1993) Genetic and nongenetic determinants of regional fat distribution. Endocr Rev 14:72–93CrossRefPubMedGoogle Scholar
  7. 7.
    Watanabe J, Tatsumi K, Ota M, Suwa Y, Suzuki S, Watanabe A, Ishibe A, Watanabe K, Akiyama H, Ichikawa Y, Morita S, Endo I (2014) The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer. Int J Color Dis 29:343–351CrossRefGoogle Scholar
  8. 8.
    Chern H, Chou J, Donkor C, Shia J, Guillem JG, Nash GM, Paty PB, Temple LK, Wong WD, Weiser MR (2010) Effects of obesity in rectal cancer surgery. J Am Coll Surg 211:55–60CrossRefPubMedGoogle Scholar
  9. 9.
    Maurovich-Horvat P, Massaro J, Fox CS, Moselewski F, O’Donnell CJ, Hoffmann U (2007) Comparison of anthropometric, area- and volume-based assessment of abdominal subcutaneous and visceral adipose tissue volumes using multi-detector computed tomography. Int J Obes 31:500–506CrossRefGoogle Scholar
  10. 10.
    Wajchenberg BL (2000) Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 21:697–738CrossRefPubMedGoogle Scholar
  11. 11.
    Yoshizumi T, Nakamura T, Yamane M, Waliul Islam AHM, Menju M, Yamasaki K, Arai T, Kotani K, Funahashi T, Yamashita S, Matsuzawa Y (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211:283–286CrossRefPubMedGoogle Scholar
  12. 12.
    Ballian N, Lubner MG, Munoz A, Harms BA, Heise CP, Foley EF, Kennedy GD (2012) Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol 105:365–370CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryHanyang University College of MedicineSeoulSouth Korea
  2. 2.Department of RadiologyHanyang University College of MedicineSeoulSouth Korea

Personalised recommendations