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. 2023 Aug;49(8):1466-1473.
doi: 10.1016/j.ejso.2023.03.235. Epub 2023 May 3.

Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy

Zewei Chen  1 , Mengqiu Yin  1 , Junhao Fu  1 , Shian Yu  2 , Nicholas L Syn  3 , Darren W Chua  4 , T Peter Kingham  5 , Wanguang Zhang  6 , Tijs J Hoogteijling  7 , Davit L Aghayan  8 , Tiing Foong Siow  9 , Olivier Scatton  10 , Paulo Herman  11 , Marco V Marino  12 , Vincenzo Mazzaferro  13 , Adrian K H Chiow  14 , Iswanto Sucandy  15 , Arpad Ivanecz  16 , Sung Hoon Choi  17 , Jae Hoon Lee  18 , Mikel Prieto  19 , Marco Vivarelli  20 , Felice Giuliante  21 , Andrea Ruzzenente  22 , Chee-Chien Yong  23 , Safi Dokmak  24 , Constantino Fondevila  25 , Mikhail Efanov  26 , Zenichi Morise  27 , Fabrizio Di Benedetto  28 , Raffaele Brustia  29 , Raffaele Dalla Valle  30 , Ugo Boggi  31 , David Geller  32 , Andrea Belli  33 , Riccardo Memeo  34 , Salvatore Gruttadauria  35 , Alejandro Mejia  36 , James O Park  37 , Fernando Rotellar  38 , Gi-Hong Choi  39 , Ricardo Robles-Campos  40 , Xiaoying Wang  41 , Robert P Sutcliffe  42 , Johann Pratschke  43 , Eric C H Lai  44 , Charing C N Chong  45 , Mathieu D'Hondt  46 , Kazuteru Monden  47 , Santiago Lopez-Ben  48 , Qu Liu  49 , Rong Liu  49 , Alessandro Ferrero  50 , Giuseppe Maria Ettorre  51 , Federica Cipriani  52 , Daniel Cherqui  53 , Xiao Liang  54 , Olivier Soubrane  55 , Go Wakabayashi  56 , Roberto I Troisi  57 , Tan-To Cheung  58 , Yutaro Kato  59 , Atsushi Sugioka  59 , Ho-Seong Han  60 , Tran Cong Duy Long  61 , David Fuks  55 , Mohammad Abu Hilal  62 , Luca Aldrighetti  52 , Kuo-Hsin Chen  9 , Bjørn Edwin  8 , Brian K P Goh  63 ; International robotic and laparoscopic liver resection study group investigators are coauthors of this study
Collaborators, Affiliations

Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy

Zewei Chen et al. Eur J Surg Oncol. 2023 Aug.

Abstract

Introduction: Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the peri-operative outcomes following laparoscopic left lateral sectionectomy (L-LLS).

Methods: A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines.

Results: A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5-36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03-1.25), operative time (MD 11 min, 95% CI 6-16), use of Pringles maneuver (RR 1.15, 95% CI 1.06-1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to -0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a "U" shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients.

Conclusion: Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections.

Keywords: Body mass index; Laparoscopic hepatectomy; Laparoscopic liver; Left lateral sectionectomy; Minimally-invasive hepatectomy; Minimally-invasive liver.

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Figures

Figure 1.
Figure 1.
Graphical representation of the modelled effect sizes from restricted cubic splines (RCS) analyses, depicting adjusted association between BMI and perioperative outcomes.
See this image and copyright information in PMC

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