Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy

Abstract

What ' s known on the subject? and What does the study add? Obesity is a common and growing problem in industrialized countries, and metabolic syndrome has been the focus of much attention recently, particularly with respect to obesity. Obesity is thought to be a major factor infl uencing surgical complexity during abdominal surgery, including laparoscopic surgery.In this study, we focused on visceral obesity which has been recognized as the most important pathogenic factor in metabolic syndrome. We found that a high visceral fat area was a signifi cant risk factor for a prolonged operating time. We believe that visceral obesity may greatly affect surgical complexity and may be a suitable index for predicting the degree of operating diffi culty associated with laparoscopic nephrectomy. OBJECTIVE• To examine the impact of visceral fat on surgical complexity in patients undergoing laparoscopic nephrectomy. PATIENTS AND METHODS• We reviewed the medical records of 121 patients who underwent laparoscopic nephrectomy from 2006 to 2010 at our institution.• The total fat area, visceral fat area (VFA) and subcutaneous fat area were measured at the level of the umbilicus using computed tomography (CT).• To identify the type of obesity, we divided VFA into ≥ 100 cm 2 and < 100 cm 2 . A VFA ≥ 100 cm 2 was used as the defi nition of visceral obesity.• We evaluated the impact of the VFA on technical diffi culties encountered during laparoscopic nephrectomy by measuring operating time. RESULTS• A signifi cant correlation was observed between body mass index (BMI) and operating time ( P < 0.001, r = 0.316) in the patients undergoing laparoscopic nephrectomy.• VFA was also signifi cantly correlated with operating time ( P < 0.001, r = 0.348), and the correlation coeffi cient of VFA was higher than that of BMI.• Multivariate analysis showed that a high VFA was an independent risk factor for prolonged operating time ( P = 0.009, odds ratio; 3.70), whereas BMI was not found to be a risk factor. CONCLUSIONS• The present data indicate that measurement of VFA by CT is of benefi t for predicting the technical diffi culty associated with laparoscopic radical nephrectomy.• Visceral obesity, which is one factor involved in metabolic syndrome, has a greater impact than BMI on the complexity of laparoscopic radical nephrectomy. KEYWORDSnephrectomy , laparoscopy , visceral obesity , metabolic syndrome , visceral fat area , renal cell carcinoma , BMI Study Type -Therapy (case series) Level of Evidence 4

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