Metabolic Syndrome, as Defined Based on Parameters Including Visceral Fat Area, Predicts Complications After Surgery for Rectal Cancer

  • Chong-Jun Zhou
  • Yi-Fan Cheng
  • Lin-Zhen Xie
  • Wan-Le Hu
  • Bo Chen
  • Lei Xu
  • Chong-Jie Huang
  • Mao Cai
  • Xian ShenEmail author
  • Chang-Bao LiuEmail author
Original Contributions



Metabolic syndrome (MetS) has become a major public health problem. However, few studies have examined the impact of MetS on the postoperative complications of colorectal cancer and the conclusions remain controversial. The present study aimed to investigate whether MetS, as defined based on visceral fat area (VFA) instead of BMI or waist circumference, would predict complications after surgery for rectal cancer.


We conducted a retrospective study of patients who underwent surgery for rectal cancer at our department between January 2013 and August 2018. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed. A receiver operating characteristic curve analysis was used to determine the gender-specific cut-off values for VFA.


A total of 381 patients were included in the study. The optimal cut-off values for VFA were 117.9 cm2 for men and 76.9 cm2 for women, and 153 patients were diagnosed as having MetS. The rate of postoperative complication was significantly higher in the MetS group than that in the non-MetS group (34.6% versus 15.8%, P < 0.001). The multivariate logistic regression analysis demonstrated that MetS (OR 3.712, P < 0.001), NRS 2002 scores ≥ 3 (OR 2.563, P = 0.001), and tumor located at the lower 1/3 (OR 3.290, P = 0.001) were independent risk factors for complications after surgery for rectal cancer.


Metabolic syndrome, as defined based on parameters including visceral fat area, was an independent risk factor for complications after surgery for rectal cancer.


Metabolic syndrome Visceral obesity Rectal cancer Postoperative complication 


Author Contributions

Chang-Bao Liu and Xian Shen contributed to the study design. Yi-Fan Cheng, Lin-Zhen Xie, Wan-Le Hu, Chong-Jie Huang, Bo Chen, and Lei Xu collected the data. Chong-Jun Zhou and Yi-Fan Cheng did the analysis and interpretation of data. Chong-Jun Zhou wrote the article. Xian Shen and Mao Cai revised the article. Chang-Bao Liu took the decision to submit the article for publication.

Funding Information

This work was supported by the foundation of Science and Technology Bureau of WenZhou (Y20170437).

Compliance with Ethical Standards

Ethics and Consent Statement

This study was approved by the ethics committee of The Second Affiliated Hospital of Wenzhou Medical University. And informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

This article does not contain any experiments with human participants or animals performed by any of the authors.


  1. 1.
    Akinyemiju T, Sakhuja S, Vin-Raviv N. In-hospital mortality and post-surgical complications among cancer patients with metabolic syndrome. Obes Surg. 2018;28(3):683–92.CrossRefGoogle Scholar
  2. 2.
    O’Neill S, O’Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015;16(1):1–12.CrossRefGoogle Scholar
  3. 3.
    Cauchy F, Zalinski S, Dokmak S, et al. Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg. 2013;100(1):113–21.CrossRefGoogle Scholar
  4. 4.
    Shiota M, Yokomizo A, Takeuchi A, et al. The feature of metabolic syndrome is a risk factor for biochemical recurrence after radical prostatectomy. J Surg Oncol. 2014;110(4):476–81.CrossRefGoogle Scholar
  5. 5.
    Berrino F, Villarini A, Traina A, et al. Metabolic syndrome and breast cancer prognosis. Breast Cancer Res Treat. 2014;147(1):159–65.CrossRefGoogle Scholar
  6. 6.
    Hu D, Peng F, Lin X, et al. Preoperative metabolic syndrome is predictive of significant gastric cancer mortality after gastrectomy: the Fujian Prospective Investigation of Cancer (FIESTA) study. EBioMedicine. 2017;15:73–80.CrossRefGoogle Scholar
  7. 7.
    You J, Liu WY, Zhu GQ, et al. Metabolic syndrome contributes to an increased recurrence risk of non-metastatic colorectal cancer. Oncotarget. 2015;6(23):19880–90.Google Scholar
  8. 8.
    Ounhasuttiyanon A, Lohsiriwat V. Metabolic syndrome and outcome after breast reconstruction. Gland Surg. 2014;3(1):85–7.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Xiang YZ, Xiong H, Cui ZL, et al. The association between metabolic syndrome and the risk of prostate cancer, high-grade prostate cancer, advanced prostate cancer, prostate cancer-specific mortality and biochemical recurrence. J Exp Clin Cancer Res. 2013;32:9.CrossRefGoogle Scholar
  10. 10.
    Wei XL, Qiu MZ, Lin HX, et al. Patients with old age or proximal tumors benefit from metabolic syndrome in early stage gastric cancer. PLoS One. 2014;9(3):e89965.CrossRefGoogle Scholar
  11. 11.
    Croft B, Reed M, Patrick C, Kovacevich N, Voutsadakis IA. Diabetes, obesity, and the metabolic syndrome as prognostic factors in stages I to III colorectal cancer patients. J Gastrointest Cancer. 2019;50(2):221–9.CrossRefGoogle Scholar
  12. 12.
    Wen YS, Huang C, Zhang X, et al. Impact of metabolic syndrome on the survival of Chinese patients with resectable esophageal squamous cell carcinoma. Dis Esophagus. 2016;29(6):607–13.CrossRefGoogle Scholar
  13. 13.
    Esposito K, Chiodini P, Colao A, et al. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care. 2012;35(11):2402–11.CrossRefGoogle Scholar
  14. 14.
    Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome. Circulation. 2009;120(16):1640–5.CrossRefGoogle Scholar
  15. 15.
    Wang S-L, Ma L-L, Chen X-Y, et al. Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy. Eur J Clin Nutr. 2017;72(3):436–45.CrossRefGoogle Scholar
  16. 16.
    Cakir H, Heus C, Verduin WM, et al. Visceral obesity, body mass index and risk of complications after colon cancer resection: a retrospective cohort study. Surgery. 2015;157(5):909–15.CrossRefGoogle Scholar
  17. 17.
    Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefGoogle Scholar
  18. 18.
    Zhao JH, Sun JX, Huang XZ, et al. Meta-analysis of the laparoscopic versus open colorectal surgery within fast track surgery. Int J Color Dis. 2016;31(3):613–22.CrossRefGoogle Scholar
  19. 19.
    Miyakita H, Sadahiro S, Saito G, et al. Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery. Int J Clin Oncol. 2017;22(2):324–31.CrossRefGoogle Scholar
  20. 20.
    Zarzavadjian Le Bian A, Denet C, Tabchouri N, et al. The effect of metabolic syndrome on postoperative outcomes following laparoscopic colectomy. Tech Coloproctol. 2018;22(3):215–21.CrossRefGoogle Scholar
  21. 21.
    Lohsiriwat V, Pongsanguansuk W, Lertakyamanee N, et al. Impact of metabolic syndrome on the short-term outcomes of colorectal cancer surgery. Dis Colon Rectum. 2010;53(2):186–91.CrossRefGoogle Scholar
  22. 22.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefGoogle Scholar
  23. 23.
    Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.CrossRefGoogle Scholar
  24. 24.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefGoogle Scholar
  25. 25.
    Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiol Rev. 2005;13(6):322–7.PubMedGoogle Scholar
  26. 26.
    Lee A, Kim YJ, Oh S-W, et al. Cut-off values for visceral fat area identifying Korean adults at risk for metabolic syndrome. Korean J Fam Med. 2018;39(4):239–46.CrossRefGoogle Scholar
  27. 27.
    Doyle SL, Bennett AM, Donohoe CL, et al. Establishing computed tomography–defined visceral fat area thresholds for use in obesity-related cancer research. Nutr Res. 2013;33(3):171–9.CrossRefGoogle Scholar
  28. 28.
    Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, et al. Metabolic dysfunction, obesity, and survival among patients with early-stage colorectal cancer. J Clin Oncol. 2016;34(30):3664–71.CrossRefGoogle Scholar
  29. 29.
    Park BK, Park JW, Ryoo S-B, et al. Effect of visceral obesity on surgical outcomes of patients undergoing laparoscopic colorectal surgery. World J Surg. 2015;39(9):2343–53.CrossRefGoogle Scholar
  30. 30.
    Oka R, Kobayashi J, Yagi K, et al. Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome. Diabetes Res Clin Pract. 2008;79(3):474–81.CrossRefGoogle Scholar
  31. 31.
    Tzimas P, Petrou A, Laou E, et al. Impact of metabolic syndrome in surgical patients: should we bother? Br J Anaesth. 2015;115(2):194–202.CrossRefGoogle Scholar
  32. 32.
    Chen W-Z, Chen X-D, Ma L-L, et al. Impact of visceral obesity and sarcopenia on short-term outcomes after colorectal cancer surgery. Dig Dis Sci. 2018;63(6):1620–30.CrossRefGoogle Scholar
  33. 33.
    Garla P, Waitzberg DL, Tesser A. Nutritional therapy in gastrointestinal cancers. Gastroenterol Clin N Am. 2018;47(1):231–42.CrossRefGoogle Scholar
  34. 34.
    Baracos VE. Cancer-associated malnutrition. Eur J Clin Nutr. 2018;72(9):1255–9.CrossRefGoogle Scholar
  35. 35.
    Goulart A, Varejao A, Nogueira F, et al. The influence of metabolic syndrome in the outcomes of colorectal cancer patients. Diabetes Metab Syndr. 2017;11(Suppl 2):S867–s71.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anorectal SurgeryThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouChina
  2. 2.The Second Clinical Medical InstituteWenzhou Medical UniversityWenzhouChina
  3. 3.Department of RadiologyThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouChina
  4. 4.Department of Gastrointestinal SurgeryThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouChina

Personalised recommendations