Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

Inoué, Yoshihiro; Ishii, Masatsugu; Fujii, Kensuke; Nihei, Kentaro; Suzuki, Yusuke; Ota, Masato; Kitada, Kazuya; Kuramoto, Toru; Shima, Takafumi; Kodama, Hiroyuki; Matsuo, Kentaro; Miyaoka, Yuta; Miyamoto, Terumasa; Yokohama, Keisuke; Ohama, Hideko; Imai, Yoshiro; Tanaka, Ryo; Sanda, Mariko; Osumi, Wataru; Tsuchimoto, Yusuke; Terazawa, Tetsuji; Ogura, Takeshi; Masubuchi, Shinsuke; Yamamoto, Masashi; Asai, Akira; Shirai, Yasutsugu; Inoue, Masayasu; Fukunishi, Shinya; Nakahata, Yoshikatsu; Takii, Michiaki; Goto, Masahiro; Kimura, Fumiharu; Higuchi, Kazuhide; Uchiyama, Kazuhisa

doi:10.1177/0003134820952448

Cited by 7 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No negative impact of obesity was observed in the current study, on intra-operative outcomes (operative time and EBL), post-operative morbidity (including composite complication rates) or mortality. This is in concordance with these previous analyses which have similarly shown no impact of obesity and increased BMI on the intra-operative and post-operative outcomes of patients undergoing laparoscopic hepatectomy [35] [36] [38] [39].…”

Section: Discussionsupporting

confidence: 92%

“…Several recent studies addressing this concern reported safety of laparoscopic hepatectomy in obese patients compared to non-obese patients, improved sur-Open Journal of Gastroenterology gical outcomes in obese patients with laparoscopic hepatectomy compared to an open approach, and no differences in oncological outcomes with minimally invasive surgery, when completed successfully [32] [33] [34]. Thus, further emphasizing the need to increase utilization of minimally invasive approach in this cohort of patients [35] [36] [37].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection

Chopra¹,

Devries²,

Mullins³

et al. 2022

OJGas

View full text Add to dashboard Cite

Introduction: Obesity is associated with an increased risk of fatty liver disease, predisposing to liver fibrosis and cirrhosis, as well as increased occurrence of hepatocellular carcinoma. Obesity is intuitively considered a risk factor for increased post-hepatectomy morbidity and mortality. Nevertheless, peer-reviewed literature reveals significant heterogeneity between different cohorts contributing to varying conclusions. Outcomes in this cohort for Laparoscopic Liver Resection (LLR), especially in non-academic settings remain under-evaluated. The current study evaluated outcomes of LLR in obese patients, in a community health system. Methods: A retrospective analysis of all patients undergoing LLR at the flagship hospital in the community health system, between 2013 and 2020, was performed. Classified into two groups based on Body Mass Index (BMI): obese (BMI > 30 kg/m 2 ) vs non-obese (BMI < 30 kg/m 2 ). Variables between groups compared with univariate analysis (Fisher exact test, student t-test, or Mann Whitney U-test). Multivariate analysis using logistic regression, was performed to determine the association of obesity with composite complication score (including bile leak, infection, bleeding, and/or cardiorespiratory complication) (p-value < 0.05). Results: 90 patients underwent LLR during the 7-year period; obese = 38 and non-obese = 52. No statistically significant differences were noted between obese and non-obese cohorts, in baseline characteristics including age (53.1 ± 15.1 vs 56.8 ± 11.6 years), female gender (60.5% vs 53.8%), and ASA grade (3.13 ± 0.53 vs 3.02 ± 0.54) (all p > 0.05). Univariate analysis showed no statistically significant differences between obese and non-obese groups, comparing estimated blood loss [300 (100 -500) vs. 200 (100 -462.5) cc], operative time [177 (125 -215) vs. 150.9 (111 -207) minutes], bile leak (2.6% vs. 4.1%), post-operative bleeding (2.6% vs. 4.1%), infection (0% vs. 4.1%), cardiorespiratory complication (10.5% vs 12.2%), conversion rate (5.3% vs 5.8%), length of stay [4 (3 -5) vs. 4 (2 -5

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection

Chopra¹,

Devries²,

Mullins³

et al. 2022

OJGas

View full text Add to dashboard Cite

show abstract

“…Regarding BMI, its association with perioperative outcomes has not been clearly defined and seems to be dependent on operative technique. [21][22][23] Moreover, data on the role of BMI in OS after liver resection is sparse, with at least one study showing no association, 24 which was corroborated in the Cox regression analysis of this study. However, our model ranked BMI highly, possibly by using extreme cut-offs or combining BMI with other features (e.g.…”

Section: Discussionsupporting

confidence: 73%

“…Differentiation grade of the primary tumor and BMI were only examined in our study. Regarding BMI, its association with perioperative outcomes has not been clearly defined and seems to be dependent on operative technique 21–23 . Moreover, data on the role of BMI in OS after liver resection is sparse, with at least one study showing no association, 24 which was corroborated in the Cox regression analysis of this study.…”

Section: Discussionmentioning

confidence: 53%

Novel machine learning algorithm can identify patients at risk of poor overall survival following curative resection for colorectal liver metastases

Amygdalos

Müller‐Franzes

Bednarsch

et al. 2022

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background/Purpose The primary cause of mortality in colorectal cancer is metastatic disease. We investigated the ability of a machine learning (ML) algorithm to stratify overall survival (OS) of patients undergoing curative resection for colorectal liver metastases (CRLM). Methods Patients undergoing curative liver resection for CRLM between 2010‐2021 at the University Hospital RWTH Aachen were eligible for this retrospective study. Patients with recurrent metastases, incomplete resections, or early deaths, were excluded. A gradient‐boosted decision tree (GBDT) model identified patients at risk of poor OS, based on clinicopathological characteristics. Differences in survival were compared with Kaplan‐Meier analysis and the log‐rank test. Results A total of 487 patients were split into training (n = 389, 80%) and test cohorts (n = 98, 20%). Of the latter, 20 (20%) were identified by the GBDT model as high‐risk and showed significantly reduced OS (23 months vs 52 months, P = .005) and increased hazard ratio (2.434, 95%CI 1.280‐4.627, P = .007). The strongest predictors were preoperative serum carcinoembryonic antigen (CEA), age, diameter of the largest metastasis, number of metastases, body mass index, and primary tumor grading. Conclusion A GBDT model can identify high‐risk patients regarding OS after curative resection of CRLM. Closer follow‐up and aggressive systemic treatment strategies may be beneficial to these patients.

show abstract

“…The surgical techniques used for LLR in this study have been previously reported. [11][12][13][14] Briefly, patients were placed in a left lateral position. Intercostal ports were inserted in 85 patients.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Risk factors for and management of morbidity in pure laparoscopic resection of the right posterosuperior segments of the liver: A multicenter retrospective study

Shinkawa

Hirokawa

Kaibori

et al. 2022

Asian J Endoscop Surgery

View full text Add to dashboard Cite

Background This study aimed to determine the risk factors for severe postoperative complications in patients undergoing pure laparoscopic liver resection (LLR) for tumors in the right posterosuperior (PS) segments. Methods The study included 289 patients who underwent parenchyma‐sparing pure LLR for tumors in the right PS segments at eight treatment centers between January 2009 and December 2019. Results Multivariate analysis revealed tumor size ≥3 cm (P = .016), segmentectomy (P = .044), and liver cirrhosis (P = .029) as independent risk factors for severe postoperative complications. The severe complication rates (2.7% vs 12.1%, P = .0025), median intraoperative blood loss (100 mL vs 150 mL, P = .001), and median operation time (248 minutes vs 299.5 minutes, P = .0013) were lower in the patients without all these three risk factors than those with at least one risk factor. The median length of postoperative hospital stay was shorter in patients with no risk factors than those with at least one risk factor (9 days vs. 10 days, P = .001). Conclusions Tumor size ≥3 cm, segmentectomy, and liver cirrhosis were the risk factors for severe postoperative complications after parenchyma‐sparing pure LLR for tumors in the right PS segments. Patients without these three risk factors would be appropriate candidates for safely performing parenchyma‐sparing pure LLR in the right PS segments at the outset.

show abstract

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

Cited by 7 publications

References 24 publications

Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection

Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection

Novel machine learning algorithm can identify patients at risk of poor overall survival following curative resection for colorectal liver metastases

Risk factors for and management of morbidity in pure laparoscopic resection of the right posterosuperior segments of the liver: A multicenter retrospective study

Contact Info

Product

Resources

About