Scientific publications
Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies
Giammauro Berardi 1 , T Peter Kingham 2 , Wanguang Zhang 3 , Nicholas L Syn 4 , Ye-Xin Koh 5 , Bashar Jaber 6 , Davit L Aghayan 7 , Tiing Foong Siow 8 , Chetana Lim 9 , Olivier Scatton 9 , Paulo Herman 10 , Fabricio Ferreira Coelho 10 , Marco V Marino 11 , Vincenzo Mazzaferro 12 , Adrian K H Chiow 13 , Iswanto Sucandy 14 , Arpad Ivanecz 15 , Sung Hoon Choi 16 , Jae Hoon Lee 17 , Mikel Gastaca 18 , Marco Vivarelli 19 , Felice Giuliante 20 , Bernardo Dalla Valle 21 , Andrea Ruzzenente 21 , Chee-Chien Yong 22 , Zewei Chen 23 , Mengqiu Yin 23 , Constantino Fondevila 24 , Mikhail Efanov 25 , Zenichi Morise 26 , Fabrizio Di Benedetto 27 , Raffaele Brustia 28 , Raffaele Dalla Valle 29 , Ugo Boggi 30 , David Geller 31 , Andrea Belli 32 , Riccardo Memeo 33 , Salvatore Gruttadauria 34 , Alejandro Mejia 35 , James O Park 36 , Fernando Rotellar 37 , Gi-Hong Choi 38 , Ricardo Robles-Campos 39 , Xiaoying Wang 40 , Robert P Sutcliffe 41 , Moritz Schmelzle 42 , Johann Pratschke 42 , Eric C H Lai 43 , Charing C N Chong 44 , Juul Meurs 45 , Mathieu D'Hondt 45 , Kazuteru Monden 46 , Santiago Lopez-Ben 47 , Qu Liu 48 , Rong Liu 48 , Alessandro Ferrero 49 , Giuseppe Maria Ettorre 50 , Federica Cipriani 51 , Franco Pascual 52 , Daniel Cherqui 52 , Junhao Zheng 53 , Xiao Liang 53 , Olivier Soubrane 54 , Go Wakabayashi 55 , Roberto I Troisi 56 , Tan-To Cheung 57 , Yutaro Kato 58 , Atsushi Sugioka 58 , Mizelle D'Silva 59 , Ho-Seong Han 59 , Phan Phuoc Nghia 60 , Tran Cong Duy Long 60 , Bjørn Edwin 7 , David Fuks 54 , Mohammad Abu Hilal 61 , Luca Aldrighetti 51 , Kuo-Hsin Chen 8 , Brian K P Goh 62 ; International robotic and laparoscopic liver resection study group investigators
Background: Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies.
Methods: This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized.
Results: A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most perioperative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P < .001), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P = .009) in obese, overweight, normal weight, and underweight patients, respectively (P < .001). However, postoperative major morbidity demonstrated a "U"-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients.
Conclusion: Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures.
CITATION Surgery 2023 Aug;174(2):259-267. doi: 10.1016/j.surg.2023.04.016. Epub 2023 Jun 3
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