Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

Abstract

Objective and BackgroundAlthough many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample.MethodsIn a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0–27.9), normal weight(BMI:18.5–23.9) and underweight(BMI<18.5). The Dindo–Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis.ResultsAccording to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications.ConclusionsLiver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.

Obesity as a surgical risk factor

“…In another large‐scale review, Mathur et al found that obese patients had significantly higher odds of having a complication than normal‐weight patients (n=3960). However, because obesity may reportedly not influence postoperative complications in some cases, it is hoped that such cases can be analyzed in a future meta‐analysis …”

“…There are fewer large‐scale reviews focusing on the influences of obesity on liver surgery than on gastrointestinal surgery. The main diseases studied are hepatocellular carcinoma and liver metastasis of colorectal cancer, but there are reviews actually targeting all hepatic disorders . Table shows a summary of past studies on the effects of obesity on outcomes of liver surgery.…”

“…Examining the influence of obesity on mortality, Kenjo et al concluded that obesity (BMI > 30) had no influence on either the 30‐day mortality rate or on the 90‐day in‐hospital mortality rate, based on developing a risk model for mortality in patients who had received hepatectomy (n = 7732). Similar results were obtained by several other investigators . Based on the aforementioned results, even in hepatectomy, obesity was considered to be associated with certain complications but did not worsen survival according to the systematic review conducted by Shimada et al.…”

Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy

“…Studies of obesity and postoperative outcomes of various surgical procedures have given inconsistent results. Some authors have reported that elevated BMI is an independent predictor of morbidity [ 31 , 32 ], whereas others have argued that complications in obese patients are directly attributable to risk factors like smoking and diabetes, while high BMI by itself is not a risk factor for postoperative complications or death, with the possible exception of increased incidence of wound infection [ 33 – 36 ]. These differences may reflect the use of different definitions and classifications of obesity, different ways of reporting postoperative complications, differences in surgical procedure, and lack of statistical power.…”

Avaliação do tratamento dos nódulos do hepatocarcinoma nos pacientes em lista de espera para transplante hepático

“…Some services keep the patient in the list after resection, while others, such as in Brazil, remove the extra score if there is resection of the nodule, and only in case of recurrence of the HCC the special situation is reestablished. Transplants in this context are known as Liver Rescue Transplantation and result in worse survival rates and high risk of relapse 15 . Chemo embolization is the gold standard treatment for patients with intermediate-stage HCC, according to the Barcelona Classification, presenting a good response in 15% to 55% of patients and an increase in the average survival from 16 to 20 months 16 .…”