Role of visceral fat on postoperative complications and relapse in patients with Crohn's disease after ileocecal resection: is it overrated?

Abstract

Abstract Introduction: The role of visceral fat in disease development, particularly in Crohn´s disease (CD), is significant, yet its preoperative prognostic value for postoperative complications and CD relapse remains unknown. This study aims to assess the predictive potential of preoperatively measured visceral and subcutaneous fat in postoperative complications and CD recurrence after ileocecal resection (ICR) using magnetic resonance imaging (MRI). Primary endpoint of the study was postoperative anastomotic leakage of the ileocolonic anastomosis, with secondary endpoints evaluating postoperative complications according to the Clavien Dindo classification and CD recurrence at the anastomosis. Methods: We conducted a retrospective analysis of 347 CD patients who underwent ICR at our tertiary referral center between 2010 and 2020. From this cohort, 223 patients with available high-quality preoperative MRI scans were included in the study. We recorded patient demographics, postoperative outcomes, and rates of CD recurrence at the anastomosis. To assess adipose tissue distribution, we measured the total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), and abdominal circumference (AC) at the lumbar 3 (L3) level using an established image-analysis method on MRI cross-sectional images. Additionally, we calculated ratios of the aforementioned values. Results: None of the radiological variables showed an association with anastomotic leakage (TFA p=0.932, VFA p=0.982, SFA p=0.951, SFA/TFA p=0.422, VFA/TFA p=0.422), postoperative complications’ rate or CD recurrence (TFA p=0.264, VFA p=0.916, SFA p=0.103, SFA/TFA p=0.059, VFA/TFA p=0.059). Conclusions: None of the radiological visceral obesity variables were associated with postoperative outcomes or clinical recurrence in CD patients undergoing ICR. Measurement of visceral fat may be a good parameter to evaluate the severity of CD activity but is rather unspecific considering the prediction of possible postoperative complications and CD relapse.