Rationale: Surgical trauma triggers Systemic Inflammatory Response (SIR) which contributes to complication development after colorectal resection . Surgical approach, operative time and blood loss influence SIR together with patient-related factors. We hypothesized that visceral adipose tissue (VAT) excess in visceral obese (VO) and sarcobese (SO) patients could intensify SIR defined with C-reactive protein (CRP) values following laparoscopic colorectal resection (CRR). Methods: CT-images were analyzed for VAT and Sarcobesity Index (SI)  in a cohort of 357 patients who underwent laparoscopic CRR. Postoperative CRP values were analyzed in the overall population and in VO and SO subgroups. Separate analysis was conducted considering infectious complications and anastomotic leak. Results: Fifty-seven patients (16%) developed infectious complications and 20 anastomotic leaks were registered (5.6%). VO and SO were not associated to these complications but higher levels of CRP were registered in the postoperative period. Infectious complications and anastomotic leak were associated to higher SIR both in VO and SO patients tough no significant difference was found. Conclusion: VO is a known risk factor for metabolic syndrome due to its pro-inflammatory effect. No data are available on the effect of VAT on SIR. We confirmed the hypothesis that VO and SO patients presented increased CRP values in the early post-operative period after laparoscopic CRR. Nonetheless, increased inflammatory response was not associated to an increased risk for infectious complications and anastomotic leak. Increased VAT is associated with higher CRP levels though the role of VAT-induced SIR on complications is still unknown.
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