Outcomes after laparoscopic intestinal resection in obese<i>versus</i>non-obese patients

Khoury, Wisam; Stocchi, Luca; Geisler, Daniel

doi:10.1002/bjs.7313

Cited by 35 publications

(26 citation statements)

References 30 publications

(21 reference statements)

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“…Our findings are concordant with the results of other large studies from Asian countries regardless of open or laparoscopic abdominal surgery [45, 46]. However, some reports had inconsistent results mainly with Western countries.…”

Section: Discussionsupporting

confidence: 93%

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

et al. 2017

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BackgroundObesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.MethodsWe reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients.ResultsA total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.ConclusionsObesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.

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Section: Discussionsupporting

confidence: 93%

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

et al. 2017

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“…A number, but not all, of those published have been able to show a correlation with increasing BMI and worsened outcome after surgery, open as well as laparoscopic [7][8][9][10]. Similar results have been shown for other major surgical cancer procedures [11].…”

Section: Introductionmentioning

confidence: 50%

Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry

Hede

Sörensson

Polleryd

et al. 2015

Int J Colorectal Dis

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Longer operating times and increased perioperative bleeding may be explanatory factors behind increased postoperative complication rates for CRC patients with higher BMI. In underweight patients, advanced disease may be a reason for a higher 30-day mortality. To improve outcome, specific precautions are suggested when operating on under- as well as overweight CRC patients. We also suggest that the registry introduces a better marker than BMI for central visceral fat-the link between obesity and cancer development. Further studies are needed to analyze the findings in detail and to study long-term effects.

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“…However, obesity, which is a patient controlled risk factor, is beyond the control of the medical community but plays an important role in surgical outcomes. Obesity is suspected to increase resection difficulty 6 and to be predictive of a complicated postoperative course, 7,8 although this premise has also been disputed. 9-11 …”

Section: Introductionmentioning

confidence: 99%

Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery

Amri

Bordeianou

Sylla

et al. 2014

The American Journal of Surgery

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Background Obese patients may face higher complication rates during surgical treatment of colon cancer. This paper aims to measure this effect in a high volume tertiary care center. Methods All colon cancer patients treated surgically at our center from 2004 through 2011 were reviewed. Multivariate regression assessed relationships of complications and stay outcomes with BMI controlled for age, gender, comorbidity score, surgical approach and history of smoking. Results In 1048 included patients, BMI was a predictor of several complications in both laparoscopic and open procedures. For every increase of BMI by one WHO category, the odds ratio (OR) was 1.61 (p<0.001) for wound infection and OR=1.54 for slow healing (p<0.001). Additionally, right colectomies had an OR=3.23 (p=0.017) for wound dehiscence. No further associations with BMI were found. Conclusions BMI was incrementally associated with wound-related complications, illustrating how the proliferation of obesity relates to a growing risk of surgical complications. As the surgical community strives to improve quality of care, patient controllable factors will play an increasingly important role in cost containment and quality improvement.

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Outcomes after laparoscopic intestinal resection in obeseversusnon-obese patients

Abstract: Laparoscopic bowel resection results in greater morbidity in obese than in non-obese individuals. This difference remains comparable whether the procedure is completed laparoscopically or converted.

Cited by 35 publications

References 30 publications

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

Influence of BMI on short-term surgical outcome after colorectal cancer surgery: a study based on the Swedish national quality registry

Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery

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