International Journal of Colorectal Disease

, Volume 33, Issue 8, pp 1019–1028 | Cite as

Visceral fat area, not body mass index, predicts postoperative 30-day morbidity in patients undergoing colon resection for cancer

  • Benjamin A. Kuritzkes
  • Emmanouil P. Pappou
  • Ravi P. Kiran
  • Onur Baser
  • Liqiong Fan
  • Xiaotao Guo
  • Binsheng Zhao
  • Stuart Bentley-Hibbert
Original Article



Colectomy for cancer in obese patients is technically challenging and may be associated with worse outcomes. Whether visceral obesity, as measured on computed tomography, is a better predictor of complication than body mass index (BMI) or determines long-term oncologic outcomes has not been well characterized. This study examines the association between derived anthropometrics and postoperative complication and long-term oncologic outcomes.


Retrospective review of patients undergoing elective colectomy for cancer at a single tertiary-care center from 2010 to 2016. Adipose tissue distribution measurements, including visceral fat area (VFA), were determined from preoperative imaging. The primary outcome was 30-day postoperative complication; secondary outcomes included overall and disease-free survival. Multivariable logistic regression was performed to determine association between obesity metrics and outcome.


Two hundred and sixty-four patients underwent 266 primary resections of colon cancer. Twenty-eight patients (10.5%) developed major morbidity (Clavien-Dindo grade ≥ III). VFA but not BMI was significantly associated with morbidity in multivariate analysis (p = 0.004, odds ratio 1.99, 95% confidence interval 1.25–3.19). No other imaging-derived anthropometric was associated with increased morbidity. In receiver operating characteristic analysis, VFA was predictive of major morbidity (area under curve 0.660). A cutoff value of VFA ≥ 191 cm2 was associated with 50% sensitivity and 76% specificity for predicting major morbidity. Patients with VFA ≥ 191cm2 had 19.4% risk of morbidity, whereas those with < 191 cm2 had 7.2% risk (relative risk ratio 2.69, unadjusted p = 0.004). Neither VFA nor BMI was associated with overall or disease-free survival.


VFA but not BMI predicts morbidity following elective surgery for colon cancer.


Colon cancer Visceral obesity Abdominal obesity Visceral fat area Clinical outcomes 



The authors would like to acknowledge Steven A. Lee-Kong, MD, and Daniel L. Feingold, MD, for their contributions to this manuscript.

Compliance with ethical standards

This study was approved by the Columbia University Medical Center Institutional Review Board with waiver of informed consent.

Conflict of interest

This manuscript has been reviewed by all authors, who declare no conflict of interest.




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Copyright information

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

Authors and Affiliations

  1. 1.Division of Colorectal SurgeryNew York Presbyterian/Columbia University Medical CenterNew YorkUSA
  2. 2.Division of Colorectal SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Center for Innovation and Outcomes ResearchNew York Presbyterian/Columbia University Medical CenterNew YorkUSA
  4. 4.Computational Image Analysis Laboratory, Department of RadiologyNew York Presbyterian/Columbia University Medical CenterNew YorkUSA
  5. 5.Division of Abdominal RadiologyNew York Presbyterian/Columbia University Medical CenterNew YorkUSA

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