腹腔鏡下右側結腸切除術における肥満の影響
目的:右側結腸癌に対する腹腔鏡下手術において，肥満が周術期成績に及ぼす影響について検討する．対象および方法:2010年4月から2013年12月までに右側結腸癌に対して腹腔鏡下手術を施行した80症例を対象とした．対象をBMI≧25およびX線CT計測法による内臓脂肪面積（以下，VFA）≧100cm2を基準値として肥満群と非肥満群に分類し，患者背景，周術期成績に関して後方視的に検討した．結果:患者背景因子，術後成績に関しては両群間で有意差を認めなかった．手術成績に関して，高VFA群で手術時間は有意に延長し（P=0.026），術中出血量も有意に増加したが（P=0.025），BMI分類では両群間に有意差...
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| Published in | 日本臨床外科学会雑誌 Vol. 75; no. 8; pp. 2091 - 2095 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.75.2091 |
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| Abstract | 目的:右側結腸癌に対する腹腔鏡下手術において，肥満が周術期成績に及ぼす影響について検討する．対象および方法:2010年4月から2013年12月までに右側結腸癌に対して腹腔鏡下手術を施行した80症例を対象とした．対象をBMI≧25およびX線CT計測法による内臓脂肪面積（以下，VFA）≧100cm2を基準値として肥満群と非肥満群に分類し，患者背景，周術期成績に関して後方視的に検討した．結果:患者背景因子，術後成績に関しては両群間で有意差を認めなかった．手術成績に関して，高VFA群で手術時間は有意に延長し（P=0.026），術中出血量も有意に増加したが（P=0.025），BMI分類では両群間に有意差を認めなかった．結語:右側結腸癌に対する腹腔鏡下手術において，手術難易度を適切に予測する肥満の指標としてはBMIよりも内臓脂肪量を反映するVFAが優れていると考えられた． |
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| AbstractList | 目的:右側結腸癌に対する腹腔鏡下手術において，肥満が周術期成績に及ぼす影響について検討する．対象および方法:2010年4月から2013年12月までに右側結腸癌に対して腹腔鏡下手術を施行した80症例を対象とした．対象をBMI≧25およびX線CT計測法による内臓脂肪面積（以下，VFA）≧100cm2を基準値として肥満群と非肥満群に分類し，患者背景，周術期成績に関して後方視的に検討した．結果:患者背景因子，術後成績に関しては両群間で有意差を認めなかった．手術成績に関して，高VFA群で手術時間は有意に延長し（P=0.026），術中出血量も有意に増加したが（P=0.025），BMI分類では両群間に有意差を認めなかった．結語:右側結腸癌に対する腹腔鏡下手術において，手術難易度を適切に予測する肥満の指標としてはBMIよりも内臓脂肪量を反映するVFAが優れていると考えられた． |
| Author | 神頭, 聡 金井, 俊平 西躰, 隆太 小西, 小百合 間中, 大 光岡, 英世 |
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| References | 5) Schwandner O, Farke S, Schiedeck TH, et al : Laparoscopic colorectal surgery in obese and nonobese patients-Do differences in body mass indices lead to different outcomes? Surg Endosc 2004 ; 18 : 1452-1456 8) VeldKamp R, Kuhry E, Hop WC, et al : Colon cancer Laparoscopic or Open Resection Study Group(COLOR). Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomized trial. Lancet Oncol 2005 ; 6 : 477-484 13) WHO Expert Consultation : Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004 ; 363 : 157-163 7) Fleshman J, Sargent DJ, Green E, et al : Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007 ; 246 : 655-662 2) Bege T, Lelong B, Francon D, et al : Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 2009 ; 23 : 1460-1464 17) Ramzi A, Liliana GB, Patricia S, et al : Obesity, outcomes and quality of care : body mass index increase the risk of wound-related complication in colon cancer surgery. Am J Surg 2014 ; 207 : 17-23 14) Tokunaga K, Matsuzawa Y, Ishikawa K, et al : A novel technique for the determination of body fat by computed tomography. Int J Obes 1983 ; 7 : 437-445 1) Pikarsky AJ, Saida Y, Yamguchi T, et al : Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 2002 ; 16 : 855-858 6) 坂元克考，間中 大，小西小百合他:腹腔鏡下結腸切除術における剥離層への提言―Terminologyとの融合―．外科治療 2010;103:511-516 3) Leroy J, Ananian P, Rubino F, et al : The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 2005 ; 241 : 69-76 12) 小島泰樹，松井隆則，上村孝法他:腹腔鏡補助下幽門側胃切除術におけるbody mass indexおよびCT計測による内臓脂肪量の影響．日消外会誌 2009;42:442-447 15) Guillou PJ, Quirke P, Thorpe H, et al : Short term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial) : multicenter, randomized controlled trial. Lancet 2005 ; 365 : 1718-1726 18) Horiuchi T, Tanishima H, Tamagawa K, et al : Randomaized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 2007 ; 62 : 212-215 9) Zhou Y, Wu L, Li X, et al : Outocome of laparoscopic colorectal surgery in obese and nonobese patients : a meta-analysis. Surg Endosc 2012 ; 26 : 783-789 11) Tsujinaka S, Konishi F, Kawamura YJ, et al : Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis colon Rectum 2008 ; 51 : 1757-1765 4) Delaney CP, Pokala N, Senagore AJ, et al : Is laparoscopic colectomy applicable to patients with body mass index>30? A case -matched comparative study with open colectomy. Dis Colon Rectum 2005 ; 48 : 975-981 10) Seki Y, Ohue M, Sekimoto M, et al : Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma : visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc 2007 ; 21 : 924-934 16) Yamamoto M, Okuda J, Tanaka K, et al : Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis colon Rectum 2013 ; 56 : 336-342 |
| References_xml | – reference: 16) Yamamoto M, Okuda J, Tanaka K, et al : Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis colon Rectum 2013 ; 56 : 336-342 – reference: 3) Leroy J, Ananian P, Rubino F, et al : The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 2005 ; 241 : 69-76 – reference: 11) Tsujinaka S, Konishi F, Kawamura YJ, et al : Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis colon Rectum 2008 ; 51 : 1757-1765 – reference: 10) Seki Y, Ohue M, Sekimoto M, et al : Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma : visceral fat reflects technical difficulty more accurately than body mass index. Surg Endosc 2007 ; 21 : 924-934 – reference: 6) 坂元克考，間中 大，小西小百合他:腹腔鏡下結腸切除術における剥離層への提言―Terminologyとの融合―．外科治療 2010;103:511-516 – reference: 15) Guillou PJ, Quirke P, Thorpe H, et al : Short term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial) : multicenter, randomized controlled trial. Lancet 2005 ; 365 : 1718-1726 – reference: 9) Zhou Y, Wu L, Li X, et al : Outocome of laparoscopic colorectal surgery in obese and nonobese patients : a meta-analysis. Surg Endosc 2012 ; 26 : 783-789 – reference: 13) WHO Expert Consultation : Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004 ; 363 : 157-163 – reference: 5) Schwandner O, Farke S, Schiedeck TH, et al : Laparoscopic colorectal surgery in obese and nonobese patients-Do differences in body mass indices lead to different outcomes? Surg Endosc 2004 ; 18 : 1452-1456 – reference: 8) VeldKamp R, Kuhry E, Hop WC, et al : Colon cancer Laparoscopic or Open Resection Study Group(COLOR). Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomized trial. Lancet Oncol 2005 ; 6 : 477-484 – reference: 17) Ramzi A, Liliana GB, Patricia S, et al : Obesity, outcomes and quality of care : body mass index increase the risk of wound-related complication in colon cancer surgery. Am J Surg 2014 ; 207 : 17-23 – reference: 18) Horiuchi T, Tanishima H, Tamagawa K, et al : Randomaized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 2007 ; 62 : 212-215 – reference: 7) Fleshman J, Sargent DJ, Green E, et al : Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007 ; 246 : 655-662 – reference: 12) 小島泰樹，松井隆則，上村孝法他:腹腔鏡補助下幽門側胃切除術におけるbody mass indexおよびCT計測による内臓脂肪量の影響．日消外会誌 2009;42:442-447 – reference: 14) Tokunaga K, Matsuzawa Y, Ishikawa K, et al : A novel technique for the determination of body fat by computed tomography. Int J Obes 1983 ; 7 : 437-445 – reference: 4) Delaney CP, Pokala N, Senagore AJ, et al : Is laparoscopic colectomy applicable to patients with body mass index>30? A case -matched comparative study with open colectomy. Dis Colon Rectum 2005 ; 48 : 975-981 – reference: 1) Pikarsky AJ, Saida Y, Yamguchi T, et al : Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 2002 ; 16 : 855-858 – reference: 2) Bege T, Lelong B, Francon D, et al : Impact of obesity on short-term results of laparoscopic rectal cancer resection. Surg Endosc 2009 ; 23 : 1460-1464 |
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| Title | 腹腔鏡下右側結腸切除術における肥満の影響 |
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