Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2021; 13(1): 19-29
Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.19
Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients
Daniel Heise, Jan Bednarsch, Andreas Kroh, Sandra Schipper, Roman Eickhoff, Marielle Coolsen, Ronald Van Dam, Sven Lang, Ulf Neumann, Florian Ulmer
Daniel Heise, Jan Bednarsch, Andreas Kroh, Sandra Schipper, Roman Eickhoff, Sven Lang, Ulf Neumann, Florian Ulmer, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany
Marielle Coolsen, Ronald Van Dam, Ulf Neumann, Department of Surgery, Maastricht University Medical Center, Maastricht 6229 HX, Netherlands
Author contributions: Neumann U, Ulmer F, Lang S and Heise D designed the clinical study; Neumann U, Ulmer F, Lang S, Coolsen M, van Dam R and Heise D performed the procedures; Bednarsch J, Kroh A, Schipper S and Eickhoff R obtained and analyzed the data; Heise D, Ulmer F and Bednarsch J wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The Institutional Review Board approval was obtained before analysis of the data (EK 423/19).
Informed consent statement: The need for patients’ informed written consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors report that there is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Heise, MD, Doctor, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstr 30, Aachen 52074, Germany. dheise@ukaachen.de
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: October 6, 2020
Revised: October 21, 2020
Accepted: November 28, 2020
Article in press: November 28, 2020
Published online: January 27, 2021
Abstract
BACKGROUND

Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.

AIM

To analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m²] and obese (BMI over 30 kg/m²) patients undergoing LH and compare postoperative outcome with patients undergoing OH.

METHODS

Perioperative data of 68 overweight (BMI over 25 kg/m²) including a subcohort of obese (BMI over 30 kg/m²) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.

RESULTS

The mean BMI was 29.8 ± 4.9 kg/m2 in the LH group and 29.7 ± 3.6 kg/m2 in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 ± 88 min vs 275 ± 131 min; P < 0.001) as well as intensive care (0.8 ± 0.7 d vs 1.1 ± 0.8 d; P = 0.031) and hospital stay (7.3 ± 3.6 d vs 15.7 ± 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 ± 81 min vs 260 ± 137 min; P = 0.009) and a reduced length of hospitalization (7.7 ± 4.3 d vs 17.2 ± 17 d; P < 0.001) but no difference in postoperative complications or overall cost.

CONCLUSION

LH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

Keywords: Laparoscopic hepatectomy, Obesity, Overweight, Morbidity, Postoperative outcome, Cost

Core Tip: Laparoscopic liver resection has emerged as a considerable alternative to conventional liver surgery. However, studies focusing on perioperative outcome after laparoscopic hepatectomy in overweight patients are still sparse and its benefit compared to open hepatectomy is a matter of debate. Our comparative analysis demonstrated that the laparoscopic approach is significantly associated with fewer postoperative complications and reduced hospital stay compared to conventional open hepatectomy in these patients.