Safety of hepatic resection in overweight and obese patients with cirrhosis

Cucchetti, Alessandro; Cescon, Matteo; Ercolani, Giorgio; Gioia, P. Di; Peri, Eugenia; Pinna, Antonio Daniele

doi:10.1002/bjs.7516

Cited by 53 publications

(40 citation statements)

References 25 publications

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“…In addition, two studies with large samples earlier indicated that obese and overweight patients did increase workload for surgeons by adding operating time or length of hospital stays[2], [26]. The findings from our study were consistent with some of the previous studies[2], [7], [9], [13], [14], not only in preoperative co-morbidities but also in postoperative outcomes. In general surgery, Dindo[9] investigated a cohort of 6336 patients and found that obese patients had similar postoperative complications except for wound infection.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, many studies[7]–[9] have suggested that obesity may have a negative impact on surgical outcomes due to associated co-morbidities, and many studies have assessed the morbidity and mortality in obese patients but the results still remain controversial. Most such studies[7], [10]–[14] were carried out in western countries and the liver resection was performed in patients with all types of liver diseases. Few studies have focused on Chinese people, in whom the prevalence of obesity and overweight has been lower.…”

Section: Introductionmentioning

confidence: 99%

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Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

et al. 2014

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Objective and BackgroundAlthough many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample.MethodsIn a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0–27.9), normal weight(BMI:18.5–23.9) and underweight(BMI<18.5). The Dindo–Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis.ResultsAccording to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications.ConclusionsLiver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

et al. 2014

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“…In a study of Cuchetti et al [24], it was shown that liver surgery can be performed safely in overweight and obese patients with HCC. There was only a significantly increase in mild respiratory complications (p = 0.044) in these patients.…”

Section: Prevention Of Phlf – What Can Be Done To Avoid Phlf?mentioning

confidence: 99%

Posthepatectomy Liver Failure

et al. 2012

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Background: Posthepatectomy liver failure (PHLF) is one of the most serious complications after liver resection and is still reported in up to 8% after liver resection. Aims: To provide an overview about the current status of risk analysis and definition of PHLF. Prevention and treatment is also discussed. Methods: A literature review was carried out on PubMed using the terms ‘liver failure’, ‘posthepatectomy’ and ‘liver surgery’ to search relevant papers. Discussion: PHLF remains a serious problem in patients undergoing major liver resection. Adequate preoperative risk assessment and an optimal postoperative treatment are essential for PHLF prevention.

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“…Overweight (BMI 25.0–29.9) and obesity (BMI ≥30.0) are significant predictors of adverse postoperative course with an increased morbidity rate after hepatic resection of 31–75 and 42–80%, respectively [41,42]. …”

Section: Pathogenesismentioning

confidence: 99%

How Much Remnant Is Enough in Liver Resection?

Guglielmi¹,

Ruzzenente²,

Conci³

et al. 2012

Dig Surg

293

204

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Background: Liver resection represents the first choice of treatment for primary and secondary liver malignancies, offering the patient the best chance of long-term survival. The extensive use of major hepatectomy increases the risk of post-hepatectomy liver failure (PHLF), which is associated with a high frequency of postoperative complications, mortality and increased length of hospital stay. Aims: The aim of this review is to investigate the different risk factors related to the occurrence of PHLF and to identify the limits for a safe liver resection in patients with normal liver and injured liver (cirrhosis, cholestasis, steatosis and post-chemotherapy liver injury). Methods: A literature search was undertaken in PubMed and related search engines, looking for articles relating to hepatic failure following hepatectomy in normal liver or injured liver. Results: In spite of improvements in surgical and postoperative management, the parameters determining how much liver can be resected are still largely undefined. A number of preoperative, intraoperative and postoperative factors all contribute to the likelihood of liver failure after surgery. The safe limits for liver resection can be estimated from the data of the literature for patients with normal liver and for those with different types of liver injury. Conclusions: Preoperative assessment that includes evaluation of liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. The critical residual liver volume for patients able to predict PHLF is mainly related to the presence of pre-existing liver disease and liver function. Among patients with normal liver, the limit for safe resection ranges from 20 to 30% future remnant liver of total liver volume. In patients with injured liver (cirrhosis, cholestasis or steatosis), preoperative assessment of the risk of PHLF should include future remnant liver volumetry and accurate liver function evaluation, including different dynamic liver function tests.

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Safety of hepatic resection in overweight and obese patients with cirrhosis

Abstract: Hepatic resection can be performed safely in overweight and obese patients with cirrhosis, although morbidity is increased in these patients.

Cited by 53 publications

References 25 publications

Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

Liver Resection in Hepatitis B-Related Hepatocellular Carcinoma: Clinical Outcomes and Safety in Overweight and Obese Patients

Posthepatectomy Liver Failure

How Much Remnant Is Enough in Liver Resection?

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