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. 2023 Aug;174(2):259-267.
doi: 10.1016/j.surg.2023.04.016. Epub 2023 Jun 3.

Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies

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

Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies

Giammauro Berardi et al. Surgery. 2023 Aug.

Abstract

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.

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Conflict of interest statement

Conflict of Interest/Disclosure: We confirm all the authors are accountable for all aspects of the work

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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