TITLE:
Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection
AUTHORS:
Asmita Chopra, Michael Devries, Rachel Mullins, Roberta Redfern, Kerri Ann Simo
KEYWORDS:
Liver Resection, Laparoscopic, Obesity, Surgical Outcomes, Minimally-Invasive
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.12 No.12,
December
29,
2022
ABSTRACT: 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 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 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. Conclusion: LLR is a key technique that can be replicated in the community setting to improve outcomes in obese patients requiring liver resection. Larger prospective multicenter studies are warranted to externally validate these findings.