Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis

Abstract

What's known on the subject? and What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese and non-obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non-obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non-obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non-obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.