To assess the perioperative recovery and short- and long-term postoperative outcomes of rectal cancer patients with different abdominal visceral fat area (VFA).

A total of 161 patients with rectal cancer treated by surgery in Shaanxi Provincial People’s Hospital from June 2016 to July 2019 were retrospectively analyzed. The clinical baseline data, perioperative recovery indicators, follow-up status of the patitents were collected, and the CT values (hounsfield unit, HU) were used to mark muscle tissue and adipose tissue differently. The VFA of the third lumbar vertebra bedding was obtained by Slice-O-Matic software. The patients were classified to high VFA group (≥134.6 cm² in males and ≥91.1 cm² in females) and low VFA group (<134.6 cm² in males and <91.1 cm² in females).

Compared with the low VFA group, the operation time was prolonged [(253.05±70.09) min vs (227.16±93.10) min, t=1.506, P=0.048], the intraoperative bleeding volume was increased [(284.06±233.43) ml vs (192.84±323.57) ml, t=2.049, P=0.042], the number of lymph node dissections was reduced [(12.84±3.39) vs (14.78±6.30), t=-2.439, P=0.016], the postoperative fasting time was prolonged [(4.76±1.13) d vs (4.25±1.04) d, t=3.012, P=0.003], the postoperative exhaust time was prolonged [(4.31±1.35) d vs (3.89±0.94) d, t=2.316, P=0.022], the gastric tube retention time was increased [(3.05±2.06) d vs (2.46±1.18) d, t=2.235, P=0.027], and the postoperative hospitalization time was increased [(14.56±6.09) d vs (12.72±5.55) d, t=2.011, P=0.046] in the high VFA group. The incidence of postoperative complications in the high VFA group was significantly higher than that in the low VFA group (27.5% vs 14.8%, χ²=3.888, P<0.05). High VFA was identified as significant prognostic factors for poorer cumulative overall survival (62.4% vs 78.9%) and cumulative disease-free survival (57.5% vs 75.9%), and the differences between the two groups were statistically significant (P<0.05).

Abdominal VFA is of certain value in the evaluation of postoperative prognosis of rectal cancer. Elevated abdominal VFA may increase the difficulty of radical resection for rectal cancer, affect the postoperative recovery and long-term survival of patients, and is associated with adverse postoperative outcome.