{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:22Z","timestamp":1789535062365,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate pre-operative assessment of surgical difficulty and post-operative risk in rectal cancer remains challenging. Conventional indices such as body mass index (BMI) fail to adequately reflect the pelvic surgical anatomy due to their systemic nature. Mesorectal fat volume\u2014an imaging-derived, site-specific parameter\u2014may better represent the operative field and associated risks, while also serving as a marker of regional adiposity relevant to nutritional and metabolic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study (2018\u20132026) analyzed 450 consecutive patients undergoing elective rectal cancer surgery with total mesorectal excision. Mesorectal fat volume was quantified using pre-operative computed tomography or magnetic resonance imaging with semi-automated segmentation. Patients were categorized into quartiles based on mesorectal fat volume. Operative outcomes and 30-day post-operative complications were compared across quartiles. Multivariable linear and logistic regression analyses were performed to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of mesorectal fat volume, BMI, and pelvic index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 450 patients were stratified into quartiles according to mesorectal fat volume (MFV). Patients in the highest MFV quartile had significantly longer operative times (182.26 \u00b1 9.28 vs. 163.03 \u00b1 9.67 min,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), greater intraoperative blood loss (169.63 \u00b1 39.00 vs. 94.55 \u00b1 40.08 mL,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), higher conversion-to-open surgery rates (27.68% vs. 5.17%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), and higher 30-day post-operative complication rates (63.39% vs. 29.31%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) than those in the lowest MFV quartile. In multivariable analyses, MFV remained an independent predictor of post-operative complications (OR = 1.37, 95% CI: 1.21\u20131.55,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), whereas BMI and pelvic index were not independently associated with complications. The multivariable prediction model demonstrated moderate discriminative ability (AUC = 0.683). Among the individual anthropometric measures, MFV demonstrated moderate discriminative ability (AUC = 0.655; 95% CI, 0.605\u20130.705), outperforming BMI (AUC = 0.552; 95% CI, 0.499\u20130.606) and pelvic index (AUC = 0.468; 95% CI, 0.415\u20130.522).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT-derived mesorectal fat volume is independently associated with increased operative difficulty and a higher risk of post-operative complications following total mesorectal excision. Compared with BMI and pelvic index, MFV provides better, although moderate, discrimination for predicting post-operative complications and may serve as a useful imaging biomarker for pre-operative risk stratification. Incorporation of MFV into multivariable prediction models may improve individualized surgical planning and perioperative risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1878649","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:31:04Z","timestamp":1789533064000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Local fat, local risk: mesorectal fat volume outperforms BMI in predicting rectal cancer surgery outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Tingting","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, Shanxi Provincial Hospital of Traditional Chinese Medicine","place":["Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junrui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Proctology, Binhai New Area Hospital of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjun","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]},{"name":"Nankai University School of Medicine, Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingsen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Huang","sequence":"additional","affiliation":[{"name":"Nankai University School of Medicine, Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiwu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Wang","sequence":"additional","affiliation":[{"name":"First Teaching Hospital of Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]},{"name":"National Clinical Research Center for Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1046\/j.1365-2168.1996.02057.x","article-title":"Mesorectal excision for rectal cancer","volume":"83","author":"Aitken","year":"1996","journal-title":"Br J Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/codi.13151","article-title":"A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery?","volume":"18","author":"Simillis","year":"2016","journal-title":"Colorectal Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/S1470-2045(14)70205-0","article-title":"Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial","volume":"15","author":"Jeong","year":"2014","journal-title":"Lancet Oncol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1056\/NEJMoa1414882","article-title":"A randomized trial of laparoscopic versus open surgery for rectal cancer","volume":"372","author":"Bonjer","year":"2015","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"dju362","DOI":"10.1093\/jnci\/dju362","article-title":"Incidence of minimally invasive colorectal cancer surgery at National Comprehensive Cancer Network centers","volume":"107","author":"Yeo","year":"2015","journal-title":"J Natl Cancer Inst."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1007\/s10350-007-9051-0","article-title":"The impact of obesity on outcome after major colorectal surgery","volume":"50","author":"Gendall","year":"2007","journal-title":"Dis Colon Rectum."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1007\/s00464-009-0829-0","article-title":"The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians","volume":"24","author":"Park","year":"2010","journal-title":"Surg Endosc."},{"key":"B8","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1093\/bja\/aev541","author":"Gurunathan","year":"2016","journal-title":"Limitations of Body Mass Index as an Obesity Measure of Perioperative Risk"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1016\/j.ejso.2018.05.027","article-title":"Obesity as a determinant of perioperative and post-operative outcome in patients following colorectal cancer surgery: a population-based study (2009\u20132016)","volume":"44","author":"Poelemeijer","year":"2018","journal-title":"Eur J Surg Oncol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1097\/DCR.0000000000001490","article-title":"Factors predicting operative difficulty of laparoscopic total mesorectal excision","volume":"62","author":"Curtis","year":"2019","journal-title":"Dis Colon Rectum."},{"key":"B11","doi-asserted-by":"publisher","first-page":"471","DOI":"10.3390\/jpm11060471","article-title":"Predictive and diagnostic biomarkers of anastomotic leakage: a precision medicine approach for colorectal cancer patients","volume":"11","author":"Gray","year":"2021","journal-title":"J Pers Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1016\/j.jamcollsurg.2013.01.007","article-title":"Quantitative measures of visceral adiposity and body mass index in predicting rectal cancer outcomes after neoadjuvant chemoradiation","volume":"216","author":"Clark","year":"2013","journal-title":"J Am Coll Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e407925","DOI":"10.1590\/acb407925","article-title":"Visceral fat assessment in rectal adenocarcinoma: the role of computed tomography, sagittal abdominal diameter, and waist circumference","volume":"40","author":"Monaco-Ferreira","year":"2025","journal-title":"Acta Cir\u00far Brasil."},{"key":"B14","doi-asserted-by":"publisher","first-page":"6258","DOI":"10.1007\/s00330-022-08697-4","article-title":"Abdominal adipose tissue quantification and distribution with CT: prognostic value for surgical and oncological outcome in patients with rectal cancer","volume":"32","author":"Pacquelet","year":"2022","journal-title":"Eur Radiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s00464-018-6331-9","article-title":"Mesorectal fat area as a useful predictor of the difficulty of robotic-assisted laparoscopic total mesorectal excision for rectal cancer","volume":"33","author":"Yamaoka","year":"2019","journal-title":"Surg Endosc."},{"key":"B16","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s00384-013-1803-9","article-title":"The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer","volume":"29","author":"Watanabe","year":"2014","journal-title":"Int J Colorectal Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1007\/s00384-015-2174-1","article-title":"Visceral obesity determined by CT scan and outcomes after colorectal surgery; a systematic review and meta-analysis","volume":"30","author":"Cakir","year":"2015","journal-title":"Int J Colorectal Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e1555","DOI":"10.1002\/onco.13824","article-title":"Total neoadjuvant therapy (TNT) versus standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis","volume":"26","author":"Liu","year":"2021","journal-title":"Oncologist."},{"key":"B19","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1097\/SLA.0000000000003471","article-title":"Total neoadjuvant therapy in rectal cancer: a systematic review and meta-analysis of treatment outcomes","volume":"271","author":"Petrelli","year":"2020","journal-title":"Ann Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s00384-022-04221-8","article-title":"Visceral-to-subcutaneous fat ratio exhibits strongest association with early post-operative outcomes in patients undergoing surgery for advanced rectal cancer","volume":"37","author":"Bocca","year":"2022","journal-title":"Int J Colorectal Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s00423-023-02888-3","article-title":"The impact of mesorectal fat area on recurrence following total mesorectal excision for lower rectal cancer","volume":"408","author":"Shioi","year":"2023","journal-title":"Langenbeck's Arch Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s40644-022-00514-x","article-title":"Associations of muscle and adipose tissue parameters with long-term outcomes in middle and low rectal cancer: a retrospective cohort study","volume":"23","author":"Liu","year":"2023","journal-title":"Cancer Imaging."},{"key":"B23","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s11701-023-01814-5","article-title":"Impact of visceral fat area on short-term outcomes in robotic surgery for mid and low rectal cancer","volume":"18","author":"Zhao","year":"2024","journal-title":"J Robot Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1097\/DCR.0000000000003147","article-title":"Using CT-based pelvimetry and visceral obesity measurements to predict total mesorectal excision quality for patients undergoing rectal cancer surgery","volume":"67","author":"Bolshinsky","year":"2024","journal-title":"Dis Colon Rectum."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3691","DOI":"10.3390\/jcm13133691","article-title":"A neuronal network-based score predicting survival in patients undergoing aortic valve intervention: the ABC-AS score","volume":"13","author":"Barbieri","year":"2024","journal-title":"J Clin Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.1093\/bjr\/tqaf174","article-title":"Citation and adherence to TRIPOD guidelines by published radiological prognostic models: systematic review","volume":"98","author":"Hameed","year":"2025","journal-title":"Br J Radiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"17145","DOI":"10.1038\/s41598-024-68147-7","article-title":"Comparative evaluation of CT and MRI in the preoperative staging of colon cancer","volume":"14","author":"Bompou","year":"2024","journal-title":"Sci Rep."},{"key":"B28","volume-title":"Transanal Total Mesorectal Excision-Safe Introduction of a New Technique.","author":"Knol","year":"2019"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e58","DOI":"10.1097\/SLA.0000000000005715","article-title":"Beyond total mesorectal excision: compartment-based anatomy of the pelvis revisited for exenterative pelvic surgery","volume":"278","author":"Stelzner","year":"2023","journal-title":"Ann Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"168","DOI":"10.56766\/ntms.1492600","article-title":"Can puborectalis muscle and abdominal subcutaneous adipose tissue thickness indicate dyssynergic defecation?","volume":"5","author":"\u00c7amur","year":"2024","journal-title":"N Trends Med Sci"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1111\/codi.16212","article-title":"Predictors of operative difficulty in robotic low anterior resection for rectal cancer","volume":"24","author":"Yuval","year":"2022","journal-title":"Colorectal Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.1245\/s10434-010-0908-4","article-title":"Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma","volume":"17","author":"Ballian","year":"2010","journal-title":"Ann Surg Oncol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1259\/bjr\/66311683","article-title":"Variation of mesorectal volume with abdominal fat volume in patients with rectal carcinoma: assessment with MRI","volume":"80","author":"Allen","year":"2007","journal-title":"Br J Radiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"109735","DOI":"10.4251\/wjgo.v18.i1.109735","article-title":"Impact of visceral obesity on postoperative complications and oncological outcomes in elderly patients with colorectal cancer","volume":"18","author":"Zhou","year":"2026","journal-title":"World J Gastrointest Oncol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1080\/13813455.2020.1733617","article-title":"The association between visceral adiposity with systemic inflammation, oxidative stress, and risk of post-surgical adhesion","volume":"128","author":"Arjmand","year":"2022","journal-title":"Arch Physiol Biochem."},{"key":"B36","doi-asserted-by":"publisher","first-page":"5853","DOI":"10.3390\/cancers15245853","article-title":"The predictors of complete pathologic response in rectal cancer during the total neoadjuvant therapy era: a systematic review","volume":"15","author":"Flom","year":"2023","journal-title":"Cancers."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1007\/s00261-022-03746-4","article-title":"Rectal cancer pelvic recurrence: imaging patterns and key concepts to guide treatment planning","volume":"48","author":"Inoue","year":"2023","journal-title":"Abdom Radiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1148\/radiol.2462070042","article-title":"Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction","volume":"246","author":"Vliegen","year":"2008","journal-title":"Radiology."},{"key":"B39","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/S1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/DCR.0b013e31827175f6","article-title":"Key factors associated with postoperative complications in patients undergoing colorectal surgery","volume":"56","author":"Manilich","year":"2013","journal-title":"Dis Colon Rectum."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1878649\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:31:18Z","timestamp":1789533078000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1878649\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":40,"alternative-id":["10.3389\/fnut.2026.1878649"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1878649","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1878649"}}