Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk

Acosta, Luis F.; García, Cézar; Dugan, Adam; Martí, Francesc; Davenport, Daniel L.; Gedaly, Roberto

doi:10.1016/j.surg.2017.07.007

Cited by 13 publications

(8 citation statements)

References 16 publications

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“…Obesity itself is a predisposing factor for colon cancer [17][18][19] and represents a wellknown risk factor for postoperative adverse events [20][21][22]. Super obesity was repeatedly identified as the strongest predictor of perioperative morbidity for different intraabdominal operations [23,24]. Reasons for worse outcomes are multifactorial and include co-morbidities, compromised intraabdominal working space associated with bulky omentum, mesentery and abdominal wall, and suboptimal visualization of highly vascularized fat wrapped anatomic structures [6][7][8][25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Aziz

Grass

Perry

et al. 2020

Surgery for Obesity and Related Diseases

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Section: Discussionmentioning

confidence: 99%

Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Aziz

Grass

Perry

et al. 2020

Surgery for Obesity and Related Diseases

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“…There is experimental and clinical data showing that hepatic regeneration is impaired in steatotic livers (9)(10)(11). However, the influence of obesity and NASH on PHLF and morbidity is unclear (3,(12)(13)(14). This study investigated postoperative outcomes after liver resection (LR) in a large cohort of patients.…”

Section: Original Articlementioning

confidence: 99%

“…Obesity is associated with hyperlipidemia, arterial hypertension and diabetes, thus representing a significant risk factor for an increased allcause mortality (2). In liver surgery, morbidly obese patients have been found to be at higher risk for a dismal outcome including surgical-site infections and major complications (3).…”

Section: Introductionmentioning

confidence: 99%

Obesity and its influence on liver dysfunction, morbidity and mortality after liver resection

Kampf¹,

Sponder²,

Fitschek³

et al. 2023

Hepatobiliary Surg Nutr

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Background: Obesity and associated steatosis is an increasing health problem worldwide. Its influence on post-hepatectomy liver failure (PHLF) and after liver resection (LR) is still unclear.Methods: Patients who underwent LR were investigated and divided into three groups [normal weight: body mass index (BMI) 18.5-24.9 kg/m 2 , overweight: BMI 25.0-29.9 kg/m 2 , obese: BMI ≥30 kg/m 2 ] in this retrospective study. Primary aim of this study was to assess the influence of BMI and nonalcoholic steatohepatitis (NASH) on PHLF and morbidity.Results: Of 888 included patients, 361 (40.7%) had normal weight, 360 (40.5%) were overweight, 167 (18.8%) were obese. Median age was 62.5 years (IQR, 54-69 years). The primary indication for LR was colorectal liver metastases (CLM) (n=366, 41.2%). NASH was present in 58 (16.1%) of normal weight, 84 (23.3%) of overweight and 69 (41.3%) of obese patients (P<0.001). PHLF occurred in 16.3% in normal weight, 15.3% in overweight and 11.4% in obese patients (P=0.32). NASH was not associated with PHLF.There was no association between patients' weight and the occurrence of postoperative complications (P=0.45). At multivariable analysis solely major LR (OR 2.7, 95% CI: 1.83-4.04; P<0.001) remained a significant predictor for PHLF.Conclusions: Postoperative complications and PHLF are comparable in normal weight, overweight and obese patients and LRs using modern techniques can be safely performed in these patients.

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“…A US study found that obese patients undergoing hepatic resection did not have a great risk of mortality, but did have a significantly higher risk of postoperative complications 12. Acosta et al 13 reported that a BMI >50 kg/m 2 as an independent predictor of perioperative morbidity after liver resection, and Gedaly et al 14 found that obesity significantly increased operating time, units of blood transfused and time to ventilator weaning after hepatic resection. A recent meta-analysis of 14 studies found that in patients undergoing liver resection for HCC, excess BMI was not associated with postoperative complications, except for wound infections, nor was it associated with prognosis 15.…”

Section: Introductionmentioning

confidence: 99%

Influence of obesity on in-hospital and postoperative outcomes of hepatic resection for malignancy: a 10-year retrospective analysis from the US National Inpatient Sample

Li²,

Deng³

et al. 2019

BMJ Open

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ObjectivesThe influence of obesity on the outcomes of curative liver resection for malignancies remains controversial. We aimed to compare the in-hospital outcomes of liver resection for malignancy between obese and non-obese patients.DesignThis was a population-based, retrospective, observational study using data from the Nationwide Inpatient Sample (NIS), the largest all-payer US inpatient care database.SettingHospitalisations of adults ≥18 years old with diagnoses of primary hepatobiliary malignancy or secondary malignant neoplasms of liver in the USA were identified from the NIS database between 2005 and 2014.ParticipantsData of 18 398 patients ≥18 years old and underwent liver resection without pancreatic resection in the NIS were extracted. All included subjects had primary hepatobiliary malignancy or secondary malignant neoplasms of the liver. Patients were divided into obese and non-obese groups. These groups were compared with respect to postoperative complications, length of hospital stay and hospital cost according to surgical extent and approach.InterventionsPatients were undergoing lobectomy of liver or partial hepatectomy.Primary and secondary outcome measuresThe primary endpoints of this study were postoperative complications, length of hospital stay and hospital cost.ResultsAfter adjustment, obese patients were significantly more likely to experience postoperative complications than were non-obese patients (adjusted OR 1.25, 95% CI 1.10 to 1.42), regardless of whether lobectomy or partial hepatectomy was performed. Furthermore, obesity was significantly associated with increased risk of postoperative complications in patients who underwent open liver resection, but not laparoscopic resection. No significant difference was observed in length of hospital stay or total hospital costs between obese and non-obese patients.ConclusionsAfter adjustment for preoperative comorbidities and other potential confounders, obesity is significantly associated with greater risk of complications in patients undergoing open liver resection for malignancy, but not laparoscopic resection.

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Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk

Cited by 13 publications

References 16 publications

Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Obesity and its influence on liver dysfunction, morbidity and mortality after liver resection

Influence of obesity on in-hospital and postoperative outcomes of hepatic resection for malignancy: a 10-year retrospective analysis from the US National Inpatient Sample

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