Body mass index and surgical outcomes in laparoscopic liver resections: a systematic review

Abstract

Background Laparoscopic liver resection is gaining momentum; however, there is limited evidence on its efficacy and safety in obese patients. The aim of this study was to examine the relationship between BMI and outcomes after laparoscopic liver resection (LLR) using a systematic review of the existing literature. Methods A systematic search of Medline (Ovid 1946–present), PubMed (NCBI), Embase (Ovid 1966–present) and Cochrane Library was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement for parameters of LLR and BMI. Operative, post‐operative and oncological outcomes were recorded. Results Of 1460 abstracts, seven retrospective studies were analysed, published between 2015 and 2017 (study periods 1998–2017). Total patient cohort were classified as 481 obese and 1180 non‐obese with a median age range of 42.5–69.4 years. Variations existed in definitions of obesity (Asia BMI >25 kg/m2, Western BMI >30 kg/m2). Rates of conversion were examined in four studies (0–31%) with one reporting BMI >28 kg/m2 as an independent risk factor. Estimated blood loss and transfusion rates were similar. Operative time was increased in obese patients in one study (P = 0.02). Mortality rates ranged from 0% to 4.3% with no difference between BMI classes. No difference in major morbidity was demonstrated. Bile leak rates were increased in obese groups in one study (0–3.44%, P < 0.05). Wound infections were reported in five studies, with higher rates in obese patients (0–5.8% versus 0–1.9%). Tumour size was comparable in both groups. Completeness of resection was analysed in four studies with one study reporting increased R0 rates in obese patients (P = 0.012). Conclusion This systematic review highlights that current evidence shows LLR in obese patients is safe, however, further studies are required.

Location of Hemangioma is an Individual Risk Factor for Massive Bleeding in Laparoscopic Hepatectomy

“…However, a recent systematic review that investigated the relationship between BMI and outcomes following laparoscopic liver resection found that the estimated blood loss rates were similar between obese and nonobese patients. 14 Although this outcome was not different, laparoscopic surgery is often more difficult in obese patients even if it can be completed safely. This factor might deserve further study.…”

Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection

“…Liver parenchyma dissection and hepatic hilum treatment are sometimes challenging despite a large skin incision and gastrointestinal tract and greater momentum compression in OLR [116][117][118]. In contrast, pneumoperitoneum, head-up position, and high magnification-even at deep portions in the caudal view-can provide sufficient free space to control the forceps in LLR, even in patients who are overweight and obese (Caudal approach, Figure 3) [119][120][121]. There is some disagreement as to whether obesity increases the risk of conversion [12,111,113,122,123], but the LLR is reported to decrease intraoperative blood loss and postoperative complications compared with OLR even in obesity [113,118,121,124].…”

“…In contrast, pneumoperitoneum, head-up position, and high magnification-even at deep portions in the caudal view-can provide sufficient free space to control the forceps in LLR, even in patients who are overweight and obese (Caudal approach, Figure 3) [119][120][121]. There is some disagreement as to whether obesity increases the risk of conversion [12,111,113,122,123], but the LLR is reported to decrease intraoperative blood loss and postoperative complications compared with OLR even in obesity [113,118,121,124]. Moreover, obesity did not affect conversion rate, operation time, or blood loss in the LLR compared with non-obesity [113,122,123].…”

Reply: Comparison between short and long‐term outcomes after minimally‐invasive versus open primary liver resections for hepatocellular carcinoma

“…The impact of BMI on the outcomes of LR has been well‐reported with contrasting results from different studies 3 . In our opinion and experience, the effect of increasing BMI on the difficulty of LR is related to the increased likelihood of hepatic steatosis and hence increasing mass/volume of the liver and transection surface 4 .…”