Impact of visceral obesity on postoperative complications and oncological outcomes in elderly patients with colorectal cancer.

[BACKGROUND] Elderly patients with colorectal cancer (CRC) can judge the risk of postoperative complications and oncological outcomes due to visceral obesity, which can provide data reference for the early prediction of prognosis.

[AIM] To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.

[METHODS] A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People's Hospital from January 2021 to June 2024 were retrospectively analyzed. Patients were divided into the abdominal [visceral fat area (VFA) ≥ 100.00 cm, = 80] and non-abdominal (VFA < 100.00 cm, = 70) obesity groups according to the VFA measured by preoperative computed tomography. The two groups showed no significant differences in age, sex, tumor location, tumor-node-metastasis stage, and underlying disease ( > 0.05). All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management. Complications, nutritional status, changes in biochemical indicators, and tumor recurrence and metastasis were evaluated postoperatively.

[RESULTS] The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group ( < 0.05). The pulmonary infection on postoperative day (POD) 3 ( = 0.038), anastomotic leakage on POD 7 ( = 0.042), and moderate-to-severe complications (Clavien-Dindo class III, = 0.03) were significantly different. With respect to biochemical indicators, the white blood cell count, neutrophil percentage, and C-reactive protein level in the abdominal obesity group continuously increased after surgery ( < 0.05); the albumin level on POD 1 was even lower ( = 0.024). Regarding tumor markers, carcinoembryonic antigen ( = 0.039) and carbohydrate antigen 19-9 ( = 0.048) levels were significantly higher in the abdominal obesity group at 3 months after surgery, and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery ( < 0.05). Abdominal obesity was an independent risk factor for postoperative complications (odds ratio: 3.843, = 0.001), overall survival [hazard ratio (HR): 1.937, = 0.011], and disease-free survival (HR: 1.769, = 0.018).

[CONCLUSION] Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis. Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.