Assessment of Factors Associated with Morbidity and Textbook Outcomes of Laparoscopic Liver Resection in Obese Patients: A French Nationwide Study

Abstract

BACKGROUND: Liver surgeons need to know the expected outcomes of laparoscopic liver resection (LLR) in obese patients. OBJECTIVE: The purpose of the present study is to assess morbidity, mortality and textbook outcomes (TO) after LLR in obese patients. METHODS: This is a French multicenter study of patients undergoing LLR between 1996 and 2018. Obesity was defined by a BMI at or above 30 kg/m2. Short-term outcomes and TO were compared between obese (ob) and nonobese (non-ob) patients. Factors associated with severe morbidity and TO were investigated. RESULTS: Of 3,154 patients included, 616 (19.5%) were obese. Ob-group patients had significantly higher American Society of Anesthesiologists (ASA) score and higher incidence of metabolic syndrome and chronic liver disease and were less likely to undergo major hepatectomy. Mortality rates were similar between ob and non-ob groups (0.8 vs 1.1%; p = 0.66). Overall morbidity and hospital stay were significantly increased in the ob group compared with the non-ob group (39.4 vs 34.7%, p = 0.03; and 9.5 vs 8.6 days, p = 0.02), whereas severe 90-day morbidity (at or above Clavien–Dindo grade III) was similar between groups (8% in both groups; p = 0.90). TO rate was significantly lower for the ob group than the non-ob group (58.3 vs 63.7%; p = 0.01). In multivariate analysis, obesity did not emerge as a risk factor for severe 90-day morbidity but was associated with a lower TO rate after LLR (odds ratio = 0.8, 95% CI 0.7–1.0; p = 0.03). CONCLUSIONS: LLR in obese patients is safe and effective with acceptable mortality and morbidity. Obesity had no impact on severe morbidity but was a factor for failing to achieve TO after LLR.

Postoperative infectious complications following laparoscopic versus open hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis of 3876 patients

“…With improvement in surgical techniques, operative devices, and perioperative care, postoperative mortality following hepatectomy has been reduced to less than 5%, and even below 1% in some experienced centers 3 , 4 . Unfortunately, the incidence of postoperative complications remains high ranging from 20 to 70% 5 – 8 . In turn, postoperative complications are independently associated with prolonged hospital stay, increased hospital costs, and a higher risk of early death 8 – 11 .…”

Textbook Outcomes After Open Live Donor Right Hepatectomy and Open Right Hepatic Lobectomy for Cancer in 686 patients

“…They reported 42% TO for normal BMI, versus 25% for low, and 25.3% for high BMI. Genser et al 51 also found that obesity was associated with a lower chance (58.3 vs 63.7%) to achieve TO in 3154 patients who underwent laparoscopic liver resection in France. In this study, which consisted of a pure open right hepatectomy cohort, no association between BMI and TO was observed.…”