Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study

Sahakyan, Mushegh А.; Røsok, Bård I.; Kazaryan, Airazat M.; Barkhatov, Leonid; Lai, Xiaoran; Kleive, Dyre; Ignjatović, Dejan; Labori, Knut Jørgen; Edwin, Bjørn

doi:10.1016/j.surg.2016.05.046

Cited by 27 publications

(19 citation statements)

References 37 publications

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“…As with hepatectomy, obesity was found to be associated with increased intraoperative blood loss . Even with other surgical procedures, such as distal pancreatectomy and central pancreatectomy, obesity was also identified as a risk factor for complications . Table shows a summary of past studies on the effects of obesity on outcomes of pancreatic surgery.…”

Section: Pancreatic Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

141

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In recent years, both the actual number of overweight/obese individuals and their proportion of the population have steadily been rising worldwide and obesity‐related diseases have become major health concerns. In addition, as obesity is associated with an increased incidence of gastroenterological cancer, the number of obese patients has also been increasing in the field of gastroenterological surgery. While the influence of obesity on gastroenterological surgery has been widely studied, very few reports have focused on individual organs or surgical procedures, using a cross‐sectional study design. In the present review, we aimed to summarize the impacts of obesity on surgeries for the esophagus, stomach, colorectum, liver and pancreas. In general, obesity prolongs operative time. As to short‐term postoperative outcomes, obesity might be a risk for certain complications, depending on the procedure carried out. In contrast, it is possible that obesity doesn't adversely impact long‐term surgical outcomes. The influences of obesity on surgery are made even more complex by various categories of operative outcomes, surgical procedures, and differences in obesity among races. Therefore, it is important to appropriately evaluate perioperative risk factors, including obesity.

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Section: Pancreatic Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

141

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“…The comparison of time, however, can only be an adequate surrogate parameter for the assessment of camera navigation quality in standardized simulation scenarios [3,8,14,19]. It is not as qualified for an intraoperative assessment, in which the procedure time is also influenced by the main surgeon's operative experience and multiple patient-specific factors [20,21]. Brackmann et al [5] state that successful camera navigation relies more on accuracy and precision than CME, complete mesocolic excision; TME, total mesorectal excision Fig.…”

Section: Discussionmentioning

confidence: 99%

Rating of camera navigation skills in colorectal surgery

Huettl

Lang

Paschold

et al. 2020

Int J Colorectal Dis

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Purpose In advanced minimally invasive surgery the laparoscopic camera navigation (LCN) quality can influence the flow of the operation. This study aimed to investigate the applicability of a scoring system for LCN (SALAS score) in colorectal surgery and whether an adequate scoring can be achieved using a specified sequence of the operation. Methods The score was assessed by four blinded raters using synchronized video and voice recordings of 20 randomly selected laparoscopic colorectal surgeries (group A: assessment of the entire operation; group B: assessment of the 2nd and 3rd quartile). Experience in LCN was defined as at least 100 assistances in complex laparoscopic procedures. Results The surgical teams consisted of three residents, three fellows, and two attendings forming 15 different teams. The ratio between experienced and inexperienced camera assistants was balanced (n = 11 vs. n = 9). Regarding the total SALAS score, the four raters discriminated between experienced and inexperienced camera assistants, regardless of their group assignment (group A, p < 0.05; group B, p < 0.05). The score's interrater variability and reliability were proven with an intraclass correlation coefficient of 0.88. No statistically relevant correlation was achieved between operation time and SALAS score. Conclusion This study presents the first intraoperative, objective, and structured assessment of LCN in colorectal surgery. We could demonstrate that the SALAS score is a reliable tool for the assessment of LCN even when only the middle part (50%) of the procedure is analyzed. Construct validity was proven by discriminating between experienced and inexperienced camera assistants.

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“…Male gender[ 3 , 15 , 21 ] or increased BMI[ 3 , 14 , 15 , 18 , 24 ] were previously found independent risk factors of overall morbidity or pancreatic fistulae in few studies including all together DP with and without splenectomy. However, most studies failed to demonstrate any correlation of male gender[ 2 , 6 - 8 , 14 , 16 - 20 , 22 - 26 ] or increased BMI[ 2 , 8 , 16 , 17 , 19 , 21 - 23 , 25 , 26 ] with morbidity after DP. In the present study, male gender and increased BMI was found the only independent risk factors for clinically relevant morbidity after SPDP.…”

Section: Discussionmentioning

confidence: 99%

“…Age[ 2 , 3 , 6 - 8 , 13 , 15 - 18 , 20 - 22 , 25 , 26 ], diabetes[ 3 , 6 , 8 , 13 - 16 , 19 , 23 , 25 , 26 ], chronic pancreatitis[ 2 , 6 , 15 , 16 , 19 , 26 ], American Society of Anesthesiologists (ASA) score[ 3 , 13 , 14 , 16 , 18 , 20 , 23 , 24 ], blood loss[ 7 , 12 - 14 , 17 , 19 , 20 , 22 , 26 ], operative time[ 2 , 3 , 12 , 13 , 15 , 19 , 21 , 22 , 26 ], soft pancreas texture[ 14 , 22 , 23 ], pathology[ 3 , 6 - 8 , 13 , 15 , 18 , 21 - 26 ] and type of approach (open or minimally invasive)[ 14 , 15 ] does not appear to be independent risk factors of overall morbidity or pancreatic fistulae after DP in most published studies, as it was the case in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies identified age[ 14 , 19 , 23 ], chronic pancreatitis[ 13 ], ASA score[ 8 ], increased operative time[ 7 , 16 , 20 ], blood loss[ 18 , 21 , 23 , 25 ], soft pancreas texture[ 18 ], neuroendocrine pathology[ 14 ] and laparoscopic approach[ 25 ] as independent risk factor for postoperative complications after DP.…”

Section: Discussionmentioning

confidence: 99%

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Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy

Dumitraşcu

Eftimie

Aiordachioae

et al. 2018

WJGS

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AIMTo identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy (SPDP). No previous studies explored potential predictors of morbidity after SPDP.METHODSThe data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni- and multivariate analyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo.RESULTSOverall morbidity rate was 34.1% (14 patients): grade I (6 patients, 14.6%), grade II (2 patients, 4.8%), grade IIIa (1 patient, 2.4%), and grade IIIb (5 patients, 12.2%). A number of 5 patients (12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients (19.5%). Univariate analysis identified male gender (P = 0.034), increased body mass index (P = 0.002) and neuroendocrine pathology (P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio (OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index (OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP.CONCLUSIONMale gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.

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Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study

Cited by 27 publications

References 37 publications

Obesity as a surgical risk factor

Obesity as a surgical risk factor

Rating of camera navigation skills in colorectal surgery

Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy

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