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Visceral adipose tissue is associated with occult synchronous peritoneal metastasis in colorectal cancer

  • Bei-bei Zhang , Han-bing Xie , Ping-ping Liu , Le Liu , Xue-meng Li , Lin Zhao , Guang-yu Wang EMAIL logo and Rui-tao Wang EMAIL logo
Published/Copyright: April 24, 2025
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Pleura and Peritoneum
From the journal Pleura and Peritoneum Volume 10 Issue 2

Abstract

Objectives

Synchronous peritoneal metastasis (PM) represents an advanced stage of colorectal cancer (CRC), indicating extensive tumor spread. Visceral adipose tissue (VAT) has been linked to cancer development and progression. This study aims to explore the relationship between VAT and occult synchronous PM in CRC patients before surgery.

Methods

We enrolled 681 CRC patients, with 419 in the primary cohort (356 non-metastatic and 63 with PM) and 262 in the validation cohort (239 non-metastatic and 23 with PM). Clinical characteristics and laboratory measurements were collected prior to surgery. Adipose and muscle tissues were delineated on preoperative contrast-enhanced computed tomography (CT) images. The association between visceral adipose tissue and synchronous PM was assessed using univariate and multivariate logistic regression analyses.

Results

In the primary cohort, 419 patients were diagnosed with CRC, with 63 presenting with PM. Patients with PM had higher visceral adipose tissue index (VATI) levels compared to those without PM. Additionally, there was a trend towards increased PM incidence with elevated VATI. Multivariate logistic regression analysis confirmed that higher VATI was independently associated with PM. These findings were consistent in the validation cohort.

Conclusions

VATI is an independent risk factor for occult synchronous PM in patients with CRC.

Keywords: colorectal cancer; visceral adipose tissue; synchronous PM

Introduction

Colorectal cancer (CRC) is the third leading cause of cancer-related mortality globally, with synchronous peritoneal metastasis (PM) occurring in 1–13 % of patients at diagnosis and conferring a poor prognosis (median survival: 4–7 months) [1], [2], [3], [4], [5], [6]. Current detection methods, including CT imaging (11 % sensitivity for lesions <5 mm) and tumor biomarkers, lack reliability for early-stage PM, underscoring the urgent need for improved markers [7], 8].

Obesity-driven dysregulation of visceral adipose tissue (VAT) may play a pivotal role in metastatic progression. Excess VAT secretes proinflammatory adipokines that foster chronic inflammation and tumor proliferation [9]. Conversely, CRC cells reprogram adjacent adipocytes into a tumor-supportive phenotype, enhancing lipolysis and aerobic glycolysis to fuel metastatic spread [10], [11], [12]. While VAT is implicated in CRC’s tumor microenvironment, its specific association with synchronous PM remains unexplored.

This study investigates VAT as a potential biomarker for synchronous PM in CRC, aiming to inform early detection strategies and therapeutic targeting of adipose-driven metastasis.

Materials and methods

Patient characteristics

We conducted a retrospective study involving CRC patients who underwent contrast-enhanced CT and radical resection from January 2021 to December 2021. Patients were recruited from two tertiary hospitals: Harbin Medical University Cancer Hospital and the Second Affiliated Hospital of Harbin Medical University. Postoperative pathological reviews of surgically resected specimens by pathologists were used to diagnose PM.

The inclusion criteria for the study were: (1) all patients had a pathological diagnosis of CRC; and (2) all patients underwent radical resection of CRC. Exclusion criteria included: (1) the presence of multiple primary cancers; (2) receipt of preoperative neoadjuvant treatment; and (3) the unavailability of clinicopathologic data (Figure S1).

The collected clinicopathological parameters comprised age, gender, body mass index (BMI), tumor location, histological type, tumor stage (T stage), nodal stage (N stage), carcinoembryonic antigen (CEA), carbohydrate antigen 19‐9 (CA19-9), hypertension, diabetes, and albumin levels. TNM staging was updated according to the eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual.

The study received approval from the Ethics Committee of Harbin Medical University Cancer Hospital and the Second Affiliated Hospital of Harbin Medical University. The requirement for informed consent was waived due to the retrospective nature of the study.

Adipose tissue imaging analysis

Adipose tissue was assessed using preoperative CT scans. The quantification of visceral and subcutaneous adipose tissues was performed at the L3 vertebral level employing Image J software version 1.53a (Wayne Rasband, National Institutes of Health, USA). For subcutaneous adipose tissue, Hounsfield Units (HU) thresholds ranged from −190 to −30. For visceral adipose tissue, the radiodensities were set between −150 and −50 HU [13], 14]. The visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were derived by normalizing the respective adipose tissue areas to the square of the patient’s height [12], 15]. The visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were derived by normalizing the respective adipose tissue areas to the square of the patient’s height.

Statistical analysis

Statistical analyses were conducted using MedCalc version 15.0 and SPSS version 26.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were expressed as means and standard deviations for normally distributed data or as medians and interquartile ranges for non-normally distributed data. Comparisons between groups were made using Student’s t-tests or Mann-Whitney U tests as appropriate. Categorical variables were analyzed using Chi-square tests. The optimal cut-off value for VATI in predicting PM was established using receiver operating characteristic (ROC) curve analysis. Risk factors for synchronous PM were initially identified through univariate analyses. Variables showing a significant association with synchronous PM (p<0.10) were further examined using a multivariate logistic regression model. A stepwise backward elimination method was applied, with variables required to have a p-value of less than 0.05 to enter the model and less than 0.10 to be removed. A p-value of less than 0.05 was considered statistically significant.

Results

This study included 419 CRC patients (mean age: 57.0 ± 10.9 years), among whom 63 (15.0 %) were diagnosed with synchronous PM. Baseline clinicopathological analysis revealed significant differences between PM and non-PM groups in the primary cohort for age, albumin levels, histological type, T stage, N stage, CEA, CA19-9, and VATI. In the validation cohort, tumor location, histological type, CEA, CA19-9, albumin, and VATI also differed significantly between groups (Tables 1 and 3).

Table 1:

The characteristics of CRC patients according to PM status in the primary cohort.

Variables Total

n=405		 PM (+)

n=49		 PM (−)

n=356		 p-Value
Age, years 57.0 ± 10.8 60.9 ± 13.4 56.5 ± 10.3 0.032
Gender, %
 Male 234 (57.8) 31 (63.3) 203 (57.0) 0.407
 Female 171 (42.2) 18 (36.7) 153 (43.0)
Tumor location, %
 Right colon 93 (23.0) 14 (28.6) 79 (22.2) 0.319
 Left colon + rectum 312 (77.0) 35 (71.4) 277 (77.8)
Histological type, %
 Adenocarcinoma 336 (83.0) 30 (61.2) 306 (86.0) <0.001
 Mucinous/Signet ring cell 69 (17.0) 19 (38.8) 50 (14.0)
T stage, %
 T1–T3 371 (91.6) 34 (1.6) 337 (94.7) <0.001
 T4 34 (8.4) 15 (98.4) 19 (5.3)
N stage, %
 N0 245 (60.5) 11 (22.4) 234 (65.7) <0.001
 N1/N2 160 (39.5) 38 (77.6) 122 (34.3)
CEA, ng/mL
 ≤5 264 (65.2) 22 (44.9) 242 (68.0) 0.001
 >5 141 (34.8) 27 (55.1) 114 (32.0)
CA19-9, U/mL
 ≤37 348 (85.9) 29 (40.8) 319 (89.6) <0.001
 >37 57 (14.1) 20 (59.2) 37 (10.4)
Hypertension
 Yes 88 (21.7) 15 (30.6) 73 (20.5) 0.108
 No 317 (78.3) 34 (69.4) 283 (79.5)
Diabetes
 Yes 43 (10.6) 7 (14.3) 36 (10.1) 0.374
 No 362 (89.4) 42 (85.7) 320 (89.9)
BMI, kg/m2 24.0 ± 3.3 24.6 ± 3.1 23.9 ± 3.4 0.128
Albumin, g/L 41.5 ± 4.3 38.8 ± 4.8 41.9 ± 4.1 <0.001
Skeletal muscle area, cm2 128.9 ± 31.0 130.0 ± 35.5 128.8 ± 30.4 0.800
Skeletal muscle index, cm2/m2 46.3 ± 9.0 47.0 ± 9.6 46.1 ± 8.9 0.531
Visceral adipose tissue area, cm2 114.9 ± 67.0 157.3 ± 65.1 109.0 ± 65.2 <0.001
Visceral adipose tissue index, cm2/m2 41.4 ± 23.7 57.4 ± 23.2 39.3 ± 23.0 <0.001
Subcutaneous adipose tissue area, cm2 134.9 ± 61.8 136.9 ± 59.9 134.6 ± 62.1 0.812
Subcutaneous adipose tissue index, cm2/m2 49.4 ± 24.2 50.4 ± 23.6 49.3 ± 24.3 0.762

  1. CRC, colorectal cancer; PM, peritoneal metastasis; CEA, carcinoembryonic antigen; carbohydrate antigen 19-9; BMI, body mass index; T stage, tumor stage; N stage, nodal stage; CA19-9, carbohydrate antigen 19‐9.

Association between VATI and PM

VATI was significantly higher in PM patients. In the primary cohort, PM patients had a mean VATI of 57.4 ± 23.2 cm2/m2 compared to 39.3 ± 23.0 cm2/m2 in non-PM patients (p<0.001) (Figure 1A). A similar trend was observed in the validation cohort, with PM patients exhibiting higher VATI (55.1 ± 24.7 cm2/m2 vs. 37.8 ± 21.5 cm2/m2; p<0.001) (Figure 1B).

Figure 1: Visceral adipose tissue index (VATI) is significantly elevated in Peritoneal Metastasis (PM) groups. (A) Primary cohort (n=405): Patients with PM exhibited higher VATI compared to non-PM patients (PM: 57.4 ± 23.2 cm2/m2 vs. non-PM: 39.3 ± 23.0 cm2/m2; p<0.001, Student’s t-test). (B) External validation cohort (n=262): consistent elevation of VATI in PM group (PM: 60.9 ± 16.7 cm2/m2 vs. non-PM: 48.7 ± 24.7 cm2/m2; p=0.003). Error bars represent mean ± SD.
Figure 1:

Visceral adipose tissue index (VATI) is significantly elevated in Peritoneal Metastasis (PM) groups. (A) Primary cohort (n=405): Patients with PM exhibited higher VATI compared to non-PM patients (PM: 57.4 ± 23.2 cm2/m2 vs. non-PM: 39.3 ± 23.0 cm2/m2; p<0.001, Student’s t-test). (B) External validation cohort (n=262): consistent elevation of VATI in PM group (PM: 60.9 ± 16.7 cm2/m2 vs. non-PM: 48.7 ± 24.7 cm2/m2; p=0.003). Error bars represent mean ± SD.

Stratified PM risk by VATI tertiles

Patients were stratified into tertiles based on VATI: T1 (≤29.92 cm2/m2), T2 (29.92–47.95 cm2/m2), and T3 (≥47.96 cm2/m2). In the primary cohort, PM prevalence increased markedly across tertiles: T1 (1.48 %, 2/135), T2 (12.59 %, 17/135), and T3 (22.22 %, 30/135; p<0.001) (Figure 2A). The validation cohort mirrored this trend, with PM rates rising from 3.2 % (T1) to 25.0 % (T3; p=0.008), confirming a dose-dependent relationship between VATI and PM risk (Figure 2B).

Figure 2: Dose-dependent association between VATI tertiles and Peritoneal Metastasis (PM) risk. (A) Primary cohort: PM prevalence escalated with increasing VATI tertiles (T1 [≤29.92 cm2/m2]: 1.48 % [2/135]; T2 [29.92–47.95 cm2/m2]: 12.59 % [17/135]; T3 [≥47.96 cm2/m2]: 22.22 % [30/135]; trend p<0.001). (B) External validation cohort: replicated dose-response relationship (T1: 3.2 % [1/31]; T2: 15.6 % [5/32]; T3: 25.0 % [8/32]; trend p=0.008).
Figure 2:

Dose-dependent association between VATI tertiles and Peritoneal Metastasis (PM) risk. (A) Primary cohort: PM prevalence escalated with increasing VATI tertiles (T1 [≤29.92 cm2/m2]: 1.48 % [2/135]; T2 [29.92–47.95 cm2/m2]: 12.59 % [17/135]; T3 [≥47.96 cm2/m2]: 22.22 % [30/135]; trend p<0.001). (B) External validation cohort: replicated dose-response relationship (T1: 3.2 % [1/31]; T2: 15.6 % [5/32]; T3: 25.0 % [8/32]; trend p=0.008).

Predictive power of VATI

ROC analysis showed that the optimal cutoff value for VATI was 43.58 cm2/m2 for PM. The specificity and sensitivity were 62.6 and 79.6 %, respectively (AUC=0.736, 95 % CI: 0.690–0.778, p<0.0001) (Figure S2).

Multivariate regression analysis

In the primary cohort, independent risk factors for PM included albumin [OR (95 % CI)=0.867 (0.797–0.944), p=0.001], mucinous/signet ring cell histology [OR (95 % CI)=2.455 (1.071–5.627), p<0.001], T4 stage [OR (95 % CI)=6.310 (2.250–17.698), p<0.001], N1/2 stage [OR (95 % CI)=6.104 (2.600–14.333), p<0.001], CA19-9≥37 U/mL [OR (95 % CI)=3.262 (1.404–7.578), p=0.006], and high VATI [OR (95 % CI)=1.029 (1.014–1.044), p<0.001]. The validation cohort identified right-sided tumors [OR (95 % CI)=3.038 (1.067–8.653), p=0.037] and CEA≥5 ng/mL [OR (95 % CI)=4.270 (1.352–13.483), p=0.013] as additional predictors, while high VATI [OR (95 % CI)=1.022 (1.001–1.044), p=0.041] remained a consistent risk factor (Tables 2 and 4).

Table 2:

Logistic regression analysis of peritoneal metastasis in the primary cohort.

Variables Univariate analysis p-Value Multivariate analysis p-Value
β OR (95 % CI) β OR (95 % CI)
Age, years 0.039 1.040 (1.010–1.071) 0.008
Histological type (mucinous/Signet ring cell vs. adenocarcinoma) 1.355 3.876 (2.028–7.408) <0.001 0.898 2.455 (1.071–5.627) 0.034
T stage (T4 vs. T1–T3) 2.057 7.825 (3.647–16.788) 0.008 1.842 6.310 (2.250–17.698) <0.001
N stage (N1/N2 vs. N0) 1.891 6.626 (3.271–13.421) <0.001 1.809 6.104 (2.600–14.333) <0.001
CEA, ng/mL

(>5 vs.≤5)		 0.958 2.605 (1.422–4.773) 0.002
CA19-9, U/mL

(>37 vs.≤37)		 1.779 5.927 (3.040–11.554) <0.001 1.182 3.262 (1.404–7.578) 0.006
Albumin, g/L −0.152 0.859 (0.804–0.918) <0.001 −0.142 0.867 (0.797–0.944) 0.001
VATI, cm2/m2 0.029 1.029 (1.017–1.042) <0.001 0.029 1.029 (1.014–1.044) <0.001

  1. T stage, tumor stage; N stage, nodal stage; VATI, visceral adipose tissue index; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; β, regression coefficient; OR, odds ratio; CI, confidence interval.

Table 3:

The characteristics of CRC patients according to PM status in the validation cohort.

Variables Total

n=262		 PM (+)

n=23		 PM (−)

n=239		 p-Value
Age, years 62.6 ± 10.7 61.2 ± 12.3 62.7 ± 12.6 0.510
Gender, %
 Male 162 (61.8) 18 (78.3) 144 (60.3) 0.089
 Female 100 (38.2) 5 (21.7) 95 (39.7)
Tumor location, %
 Right colon 80 (30.5) 13 (56.5) 67 (28.0) 0.005
 Left colon + rectum 182 (69.5) 10 (43.5) 172 (72.0)
Histological type, %
 Adenocarcinoma 208 (79.4) 11 (47.8) 197 (82.4) <0.001
 Mucinous/Signet ring cell 54 (20.6) 12 (52.2) 42 (17.6)
T stage, %
 T1–T3 241 (92.0) 19 (82.6) 222 (92.9) 0.098
 T4 21 (8.0) 4 (17.4) 17 (7.1)
N stage, %
 N0 170 (64.9) 13 (56.5) 157 (65.7) 0.379
 N1/N2 92 (35.1) 10 (43.5) 82 (34.3)
CEA, ng/mL
 ≤5 168 (64.1) 5 (21.7) 163 (68.2) <0.001
 >5 94 (35.9) 18 (78.3) 76 (31.8)
CA19-9, U/mL
 ≤37 230 (87.8) 13 (56.5) 217 (90.8) <0.001
 >37 32 (12.2) 10 (43.5) 22 (9.2)
Hypertension
 Yes 95 (36.3) 6 (26.1) 89 (37.2) 0.288
 No 167 (63.7) 17 (73.9) 150 (62.8)
Diabetes
 Yes 36 (10.6) 3 (13.0) 33 (13.8) 1.000
 No 226 (89.4) 20 (87.0) 206 (86.2)
Albumin, g/L 42.8 ± 5.2 40.3 ± 3.3 43.1 ± 3.3 0.013
Visceral adipose tissue area, cm2 139.1 ± 70.9 173.1 ± 51.2 135.8 ± 71.7 0.003
Visceral adipose tissue index, cm2/m2 49.8 ± 24.4 60.9 ± 16.7 48.7 ± 24.7 0.003

  1. CRC, colorectal cancer; PM, peritoneal metastasis; T stage, tumor stage; N stage, nodal stage; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9.

Table 4:

Logistic regression analysis of peritoneal metastasis in the validation cohort.

Variables Univariate analysis p-Value Multivariate analysis p-Value
β OR (95 % CI) β OR (95 % CI)
Gender (male vs. female) 0.865 2.375 (0.853–6.614) 0.098
Tumor location (left colon+Rectum vs. right colon) 1.592 4.914 (2.035–11.863) <0.001 1.111 3.038 (1.067–8.653) 0.037
Histological type (mucinous/Signet ring cell vs. Adenocarcinoma) 1.633 5.117 (2.115–12.378) <0.001 1.731 5.648 (1.939–16.448) 0.002
T stage (T4 vs. T1-T3) 1.011 2.749 (0.840–8.998) 0.095
CEA, ng/mL

(>5 vs.≤5)		 2.019 7.532 (2.695–21.050) <0.001 1.452 4.270 (1.352–13.483) 0.013
CA19-9, U/mL

(>37 vs.≤37)		 2.008 7.448 (2.927–18.951) <0.001 1.117 3.055 (1.008–9.256) 0.048
Albumin, g/L −0.121 0.886 (0.808–0.970) 0.009 −0.118 0.889 (0.792–0.997) 0.044
VATI, cm2/m2 0.020 1.020 (1.003–1.038) 0.024 0.022 1.022 (1.001–1.044) 0.041

  1. VATI, visceral adipose tissue index; T stage, tumor stage; CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; β, regression coefficient; OR, odds ratio; CI, confidence interval.

Discussion

Given the significant burden of PM in terms of mortality, PM is traditionally perceived as a terminal condition. Our study identifies VATI as an independent predictor of synchronous PM in CRC, addressing a critical gap in CRC metastasis research. These findings position VATI as a practical biomarker for preoperative risk stratification, enabling targeted interventions such as enhanced imaging (e.g., diagnostic laparoscopy) or prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in high-risk patients.

Previous studies have demonstrated that VAT is associated with postoperative complications and overall survival [16], 17]. Excess fat accumulation triggers inflammatory mediator release, establishing a chronic inflammatory state [18]. Within this inflamed tumor microenvironment, hypertrophic adipocytes secrete adipokines and cytokines that promote tumor proliferation, angiogenesis, and progression [19]. VAT overproduces leptin in obesity, activating its receptor on CRC cells. This triggers JAK2/STAT3 signaling, upregulating pro-survival genes (e.g., BCL-2) and epithelial-mesenchymal transition transcription factors (e.g., SNAIL, TWIST) [20]. Moreover, leptin induces blood vessel formation through the PI3K-Akt-mTOR pathway, facilitating peritoneal invasion [21]. On the contrary, adiponectin inhibits CRC proliferation by activating AMPK, suppressing mTOR-driven protein synthesis [15]. Low adiponectin levels in VAT-rich patients depress mTOR, accelerating liver metastasis [22]. Crown-like structures in VAT secrete IL-6 and TNF-α via NF-κB activation [13], 23]. IL-6 binds to IL-6 receptor on CRC cells, activating STAT3 to upregulate CCL2 (macrophage recruitment) [14]. TNF-α promotes Wnt/β-catenin signaling, enhancing stemness and chemoresistance in metastatic CRC [24], 25]. Additionally, the colon’s direct anatomical connection to visceral fat allows tumors to penetrate the serous membrane and invade the omentum/mesentery [26]. Once in the peritoneal cavity, cancer cells form mobile thrombi, degrade extracellular matrix components, and implant into mesothelial tissues, ultimately driving peritoneal metastasis [27]. However, more research is needed to clarify the precise mechanism of VAT in the development of PM in CRC.

Consistent with other results, our study revealed that primary tumor location, CA19-9, and histological type were the independent risk factors for synchronous PM. Right-sided tumors have a higher risk for PM, which has been confirmed by prior studies [28], [29], [30]. Higher pretreatment CA19-9 levels indicate a more advanced TNM stage and are associated with poor pathological type [31]. Furthermore, mucinous/signet ring cell histological type was also consistently identified as a key clinical predictor of synchronous PM [32]. Our preliminary data showed that VATI, combined with tumor markers (CEA and CA19-9), forms a robust predictive model for PM (Figure S3). Further confirmatory research is needed.

Our findings have significant implications for clinical practice. Current screening relies heavily on CT/MRI, which may miss micrometastases. Integrating VATI into preoperative risk stratification could prioritize high-risk patients and optimize surveillance intervals. High-VATI patients may warrant advanced imaging (PET-CT) or diagnostic laparoscopy to detect occult peritoneal deposits and undergo shorter-interval follow-up to improve early detection rates. For high VATI patients undergoing curative resection, hyperthermic intraperitoneal chemotherapy or extended peritoneal lavage should be considered to mitigate metastasis risk. VATI reflects a pro-metastatic adipose microenvironment. Pharmacologic inhibition of VAT-associated mediators may disrupt PM progression. In addition, high VATI correlates with immunosuppressive tumor microenvironment [19], 33]. Earlier introduction of immune checkpoint inhibitors in high-VATI subgroups could be considered in future clinical trials.

This study has several limitations. First, as a retrospective analysis, prospective validation in multiethnic cohorts is needed. Second, although VAT is significant in the development of PM, the underlying mechanisms remain unclear. Finally, some factors such as dietary habits, physical activity, or genetic predispositions could influence VATI and CRC progression [34], [35], [36]. In addition, both gender and ethnicity significantly influence VAT distribution [37]. Therefore, future clinical research should take these possible confounders into account.

Conclusions

Visceral adipose tissue index independently predicts synchronous peritoneal metastasis in CRC. Our findings advocate for VATI-guided risk stratification while underscoring the need to investigate adipose-driven metastatic mechanisms.

Corresponding author: Guang-yu Wang, Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, 150081, China, E-mail: ; and Rui-tao Wang, Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, 150081, China, E-mail:
Bei-bei Zhang and Han-bing Xie contributed equally to this work and share first authorship.

Funding source: Climbing program of Harbin Medical University Cancer Hospital

Award Identifier / Grant number: (PDTS2024B-01)

Acknowledgments

This work was supported by Climbing program of Harbin Medical University Cancer Hospital (PDTS2024B-01).

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: Conceptualization: BBZ and RTW; Writing – original draft: HBX; Data curation: PPL and LL; Validation: XML and LZ; Writing – review and editing: RTW; Visualization: GYW.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: Climbing program of Harbin Medical University Cancer Hospital (PDTS2024B-01).

  7. Data availability: The data used to support the findings of this study are available from the corresponding author upon request.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/pp-2024-0030).

Received: 2024-12-05
Accepted: 2025-04-07
Published Online: 2025-04-24

© 2025 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. The microbiome of pseudomyxoma peritonei: a scoping review
  4. Research Articles
  5. Implementation of an enhanced recovery after surgery (ERAS) program in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: study protocol for a prospective multicenter interventional trial (EPICH study)
  6. The impact of surgical staging in patients with colorectal peritoneal metastases scheduled for CRS-HIPEC
  7. Immediate postoperative effects of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using carboplatin on peritoneal tissue inflammatory and ischemic responses: an explorative porcine study
  8. Visceral adipose tissue is associated with occult synchronous peritoneal metastasis in colorectal cancer
  9. Optimizing patient recovery: prospective study evaluating compliance and clinical outcomes of enhanced recovery protocols in ovarian cancer following cytoreductive surgery with HIPEC
https://doi.org/10.1515/pp-2024-0030
Keywords for this article
colorectal cancer; visceral adipose tissue; synchronous PM
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. The microbiome of pseudomyxoma peritonei: a scoping review
  4. Research Articles
  5. Implementation of an enhanced recovery after surgery (ERAS) program in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: study protocol for a prospective multicenter interventional trial (EPICH study)
  6. The impact of surgical staging in patients with colorectal peritoneal metastases scheduled for CRS-HIPEC
  7. Immediate postoperative effects of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using carboplatin on peritoneal tissue inflammatory and ischemic responses: an explorative porcine study
  8. Visceral adipose tissue is associated with occult synchronous peritoneal metastasis in colorectal cancer
  9. Optimizing patient recovery: prospective study evaluating compliance and clinical outcomes of enhanced recovery protocols in ovarian cancer following cytoreductive surgery with HIPEC
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