Laparoscopic Liver Resection can be an Effective Way in Obese Patients: A Single Center of 2-Year Experience

Yu, Haibo; Dong, Ya-dong; Wang, Liancai; Tian, Guangjin; Mu, Senmao; Cao, Yuan; Peng, Yanan; Lou, Chong-yang; Liu, Peng; Li, Deyu

doi:10.1097/sle.0000000000000268

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…This result clearly contrasts that for open resection, suggesting that this surgical approach has distinct advantages in this patient population. Similar observations have been reported in numerous smaller cohort studies of hepatic resection in obese patients 24–27. The laparoscopic approach to hepatic resection dramatically decreases surgical wall trauma, as only five or six port incisions are made, and the resected specimen is extracted without a muscle incision 28.…”

Section: Discussionsupporting

confidence: 78%

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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Section: Discussionsupporting

confidence: 78%

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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“…However, LLR in obese patients is considered problematic. Despite this, several reports have stated that obesity should not be a contraindication for LLR [21, 22] and that LLR was less influenced by BMI and was beneficial in obese patients [23, 24]. In our case, despite the patient being severely obese (BMI 40 kg/m 2 ), LLR of the three separate lesions was successfully performed without excessive blood loss.…”

Section: Discussionmentioning

confidence: 62%

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

et al. 2019

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Background Hepatocellular adenoma (HCA) is a rare liver tumor that has the potential for rupture and malignant transformation. Here, we report a case of multiple hepatocellular adenomas (HCAs) that were treated by surgical resection. Case presentation An 18-year-old man was admitted to our hospital with proteinuria. His height was 176.5 cm, weight was 126 kg, and body mass index was 40 kg/m 2 . A liver tumor was incidentally found on abdominal ultrasonography. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed three hepatic tumors that were 68 mm, 16 mm, and 9 mm in segments 3/4, 8, and 1, respectively. A percutaneous needle biopsy of the largest tumor was performed, the diagnosis of unclassified type HCA was made, and laparoscopic partial liver resection was performed of all three. The postoperative course was uneventful, and the patient was discharged 12 days later. An immunohistochemical examination revealed positivity for serum amyloid A protein, no decrease in fatty acid-binding protein, and negativity for β-catenin, glutamine synthetase, and cytokeratin 7. Therefore, these tumors were diagnosed as inflammatory type HCAs. Conclusions We reported an extremely rare case of multiple resected HCAs in a young, obese Japanese man. Our findings suggest that HCA should be considered in the differential diagnosis of liver tumor in obese patients. Further studies that consider clinical and molecular risk factors are required to establish individualized treatment plans for HCA in obese patients.

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“…Normal weight and overweight were considered BMI of <25 and 25–30, respectively 15,16 . The three studies from Japan 17,18,20 and one from China 21 defined obesity as a BMI of ≥25 kg/m 2 . One such study categorized patients with a BMI ≥30 kg/m 2 as highly obese 20 .…”

Section: Resultsmentioning

confidence: 99%

“…Rates of conversion to open laparotomy were examined in four studies (Table 3), ranging from 0% to 31% 16,19–21 . Only one study found rates of conversion were higher in obese patients (31%) compared to normal (11.5%) and overweight (13%) patients ( P = 0.03).…”

Section: Resultsmentioning

confidence: 99%

Body mass index and surgical outcomes in laparoscopic liver resections: a systematic review

Kwan

Waters

Keogh

et al. 2021

ANZ Journal of Surgery

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Background Laparoscopic liver resection is gaining momentum; however, there is limited evidence on its efficacy and safety in obese patients. The aim of this study was to examine the relationship between BMI and outcomes after laparoscopic liver resection (LLR) using a systematic review of the existing literature. Methods A systematic search of Medline (Ovid 1946–present), PubMed (NCBI), Embase (Ovid 1966–present) and Cochrane Library was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement for parameters of LLR and BMI. Operative, post‐operative and oncological outcomes were recorded. Results Of 1460 abstracts, seven retrospective studies were analysed, published between 2015 and 2017 (study periods 1998–2017). Total patient cohort were classified as 481 obese and 1180 non‐obese with a median age range of 42.5–69.4 years. Variations existed in definitions of obesity (Asia BMI >25 kg/m2, Western BMI >30 kg/m2). Rates of conversion were examined in four studies (0–31%) with one reporting BMI >28 kg/m2 as an independent risk factor. Estimated blood loss and transfusion rates were similar. Operative time was increased in obese patients in one study (P = 0.02). Mortality rates ranged from 0% to 4.3% with no difference between BMI classes. No difference in major morbidity was demonstrated. Bile leak rates were increased in obese groups in one study (0–3.44%, P < 0.05). Wound infections were reported in five studies, with higher rates in obese patients (0–5.8% versus 0–1.9%). Tumour size was comparable in both groups. Completeness of resection was analysed in four studies with one study reporting increased R0 rates in obese patients (P = 0.012). Conclusion This systematic review highlights that current evidence shows LLR in obese patients is safe, however, further studies are required.

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Laparoscopic Liver Resection can be an Effective Way in Obese Patients: A Single Center of 2-Year Experience

Abstract: Obesity should not be seen as a contraindication for laparoscopic liver resection, which is a safe and feasible procedure for obese patients.

Cited by 10 publications

References 22 publications

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

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

Case of resected multiple hepatocellular adenomas in a young man with severe obesity

Body mass index and surgical outcomes in laparoscopic liver resections: a systematic review

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