Giammauro Berardi, T Peter Kingham, Wanguang Zhang, Nicholas L Syn, Ye-Xin Koh, Bashar Jaber, Davit L Aghayan, Tiing Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Moritz Schmelzle, Johann Pratschke, Eric C H Lai, Charing C N Chong, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Qu Liu, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Franco Pascual, Daniel Cherqui, Junhao Zheng, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Mohammad Abu Hilal, Luca Aldrighetti, Kuo-Hsin Chen, Brian K P Goh
Surgery 174(2) 259-267 2023年8月
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.