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

Open Journal of Gastroenterology 2022年第12期12卷 347-360页

作者： Asmita Chopra Michael Devries rachel mullins Roberta Redfern Kerri Ann Simo Department of Surgery University of Toledo School of Medicine Toledo Ohio Promedica Health System Toledo Hospital Toledo Ohio

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/m2) vs non-obese (BMI 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) days], 90-day reoperation (0% vs. 2%) and 90-day readmission (2.6% vs. 4.1%) (p > 0.05). Multivariate analysis showed no association between obesity and composite complication rate (p = 0.97), after adjusting for alcohol abuse, neoadjuvant therapy, and prior liver surgery. Co

关键词： Liver Resection Laparoscopic Obesity Surgical Outcomes Minimally-Invasive

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