Introduction
Hospitalization and surgical procedures affect normal homeostasis and trigger metabolic stress response. This process is commonly called Systemic Inflammatory Response or Surgical Stress Response (SSR), and involves both immune and neuro-endocrine systems 1.
Several approaches have been proposed for assaying SSR in clinical practice, with C-reactive protein (CRP) measurement remaining the most used and affordable strategy. In colorectal surgery several studies confirmed the usefulness of CRP for safe early discharge, aiming at early detection of adverse events 2. Conversely, several procedure- and patient-related factors could influence SSR, so that specific subgroups of patients may need the estimation and application of specific cut-off values. Among these factors, surgical approach and nutritional status have been recently found to be associated with SSR 3–5. In particular, low skeletal muscle mass has been associated with increased SSR 4, whilst little is known on the post-operative pro-inflammatory role of visceral obesity (VO) and its possible clinical implications.
In this study, we assessed the relationship between visceral adipose tissue (VAT) area measured at CT scan and SSR defined according to peri-operative CRP levels. We assumed that VO, defined as VAT excess, could intensify SSR following laparoscopic colorectal surgery, thus requiring specific cut-off values for detecting post-operative infectious complications in VO patients.