Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Montanè, Bryce; Toosi, Kavian; Velez-Cubian, Frank O.; Echavarria, M.; Thau, Matthew R.; Patel, Raj A; Rodriguez, Kathryn; Moodie, Carla; Garrett, Joseph; Fontaine, Jacques; Toloza, Eric M.

doi:10.1177/1553350616687435

Cited by 14 publications

(9 citation statements)

References 43 publications

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“…In particular, our findings are in contrast with St Julien et al that investigated the database of the society of thoracic surgeons and observed an increased operating time by 7.2 min for every 10-unit increase in BMI [ 29 ]. On the other hand, our results were in line with a recent study on RATS lobectomy that demonstrated equivalence in surgical time between obese and non-obese patients [ 24 ].…”

Section: Discussionsupporting

confidence: 91%

“…For all these reasons, it could be intuitive that patients with elevated BMI developed more frequently post-operative complications. Nevertheless, the current literature presents contradictory results on this topic, and the “obesity paradox,” namely the protective effect of obesity on complication incidence, has been observed also in the thoracic surgery cohort analysis [ 24 – 28 ]. On the other hand, several studies presented a higher incidence of complications (notably pulmonary ones) in obese patients submitted to thoracic surgery [ 12 , 21 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

et al. 2021

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Objectives Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry. Methods The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity. Results From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%). Conclusion Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

et al. 2021

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“…The obese patients have a higher risk for pneumonia, atelectasis, and other postoperative complications [ 33 , 34 ]. HFNC with high adherence rate, comfortable experience, and lower costs has emerged as a new oxygen supportive treatment, but the efficacy of HFNC for obese patients during the perioperative period is controversial.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Zhou

Wang

2022

Canadian Respiratory Journal

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Background. Obesity is a risk factor for severe airway obstruction and hypoxemia. High-flow nasal cannula (HFNC) is considered as a novel method for oxygen therapy, but the efficacy of HFNC for obese patients is controversial. This meta-analysis aimed to assess the efficacy of HFNC compared with conventional oxygen therapy (COT) in obese patients during the perioperative period. Methods. We searched the PubMed, Embase, Web of Science, the Cochrane Library, and Google scholar databases for randomized controlled trials (RCTs) that compared the efficacy of HFNC with COT in obese patients during the perioperative period. The primary outcome was the incidence of hypoxemia, while the secondary outcomes included the lowest SpO2, the need for additional respiratory support, and the hospital length of stay (LOS). Results. Twelve trials with 798 obese patients during the perioperative period were included. Compared with COT, HFNC reduced the incidence of hypoxemia (RR, 0.60; 95% CI, 0.43 to 0.83; P = 0.002 ; I2 = 24%; 8 RCTs; n = 458), increased the lowest SpO2 (MD, 2.88; 95% CI, 1.53 to 4.22; P < 0.0001 ; I2 = 32%; 5 RCTs; n = 264), decreased the need for additional respiratory support (RR, 0.43; 95% CI, 0.21 to 0.88; P = 0.02 ; I2 = 0%; 3 RCTs; n = 305), and shortened the hospital LOS (MD, −0.31; 95% CI, −0.57 to −0.04; P = 0.02 ; I2 = 0%; 3 RCTs; n = 214). Conclusions. This meta-analysis showed that compared with COT, the use of HFNC was able to reduce the incidence of hypoxemia, increase the lowest SpO2, decrease the need for additional respiratory support, and shorten the hospital LOS in obese patients during the perioperative period. Well-organized trials with large sample size should be conducted to support our findings.

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“…In fact, there is considerable disagreement within the literature about the effect of obesity on pneumonia following lung cancer surgery, as some studies also found a protective effect of obesity or higher BMI, 39 , 40 , 41 whereas other studies have found obesity to be a risk factor. 4 , 42 , 43 …”

Section: Commentmentioning

confidence: 99%

Evaluation of gastroesophageal reflux disease and hiatal hernia as risk factors for lobectomy complications

Kaminski

Ermer

Canavan³

et al. 2022

JTCVS Open

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Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Abstract: Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with "normal weight" and "overweight" patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.

Cited by 14 publications

References 43 publications

Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Evaluation of gastroesophageal reflux disease and hiatal hernia as risk factors for lobectomy complications

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