Scientific publications

Indications, trends, and perioperative outcomes of minimally invasive and open liver surgery in non-obese and obese patients: An international multicentre propensity score matched retrospective cohort study of 9963 patients. Scientific Publication

Nov 14, 2022 | Magazine: International Journal Surgery

Giuseppe Zimmitti  1 , Jasper P Sijberden  2 , Daniel Osei-Bordom  3 , Nadia Russolillo  4 , Davit Aghayan  5 , Jacopo Lanari  6 , Federica Cipriani  6 , Santi López-Ben  7 , Fernando Rotellar  8 , David Fuks  9 , Mathieu D'Hondt  10 , John N Primrose  11 , Burak Görgec  12 , Andrea Benedetti Cacciaguerra  13 , Ravi Marudanayagam  3 , Serena Langella  4 , Marco Vivarelli  13 , Andrea Ruzzenente  14 , Marc G Besselink  12 , Adnan Alseidi  15 , Mikhail Efanov  16 , Felice Giuliante  17 , Ibrahim Dagher  18 , Elio Jovine  19 , Fabrizio di Benedetto  20 , Luca A Aldrighetti  6 , Umberto Cillo  21 , Bjørn Edwin  5 , Alessandro Ferrero  4 , Robert P Sutcliffe  3 , Mohammed Abu Hilal  22


Background: Despite the worldwide increase of both obesity and use of minimally invasive liver surgery(MILS), evidence regarding the safety and eventual benefits of MILS in obese patients is scarce. The aim of this study was therefore to compare the outcomes of non-obese and obese patients(BMI 18.5-29.9 and BMI≥30, respectively) undergoing MILS and OLS, and to assess trends in MILS use among obese patients.

Methods: In this retrospective cohort study, patients operated at 20 hospitals in eight countries(2009-2019) were included and the characteristics and outcomes of non-obese and obese patients were compared. Thereafter, the outcomes of MILS and OLS were compared in both groups after propensity-score matching(PSM). Changes in the adoption of MILS during the study period were investigated.

Results: Overall, 9963 patients were included(MILS:n = 4687; OLS:n = 5276). Compared to non-obese patients(n = 7986), obese patients(n = 1977) were more often comorbid, less often received preoperative chemotherapy or had a history of previous hepatectomy, had longer operation durations and more intraoperative blood loss(IOBL), paralleling significantly higher rates of wound- and respiratory-related complications. After PSM, MILS, compared to OLS, was associated, among both non-obese and obese patients, with less IOBL(200 ml vs 320 ml,200 ml vs 400 ml, respectively), lower rates of transfusions(6.6% vs 12.8%,4.7% vs 14.7%), complications(26.1% vs 35%,24.9% vs 34%), bile leaks(4% vs 7%,1.8% vs 4.9%), liver failure (0.7% vs 2.3%,0.2% vs 2.1%), and a shorter length of stay(5vs7 and 4vs7 days). A cautious implementation of MILS over time in obese patients(42.1%-53%,p < .001) was paralleled by stable severe morbidity(p = .433) and mortality(p = .423) rates, despite an accompanying gradual increase in surgical complexity.

Conclusions: MILS is increasingly adopted and associated with perioperative benefits in both non-obese and obese patients.

CITATION Int J Surg. 2022 Nov;107:106957. doi: 10.1016/j.ijsu.2022.106957. Epub 2022 Oct 14.