Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy
Authors
Zewei Chen ; Mengqiu Yin ; Junhao Fu ; Shian Yu ; Nicholas L Syn ; Darren W Chua ; T Peter Kingham ; Wanguang Zhang ; Tijs J Hoogteijling ; Davit L Aghayan ; Tiing Foong Siow ; Olivier Scatton ; Paulo Herman ; Marco V Marino ; Vincenzo Mazzaferro ; Adrian K H Chiow ; Iswanto Sucandy ; Arpad Ivanecz ; Sung Hoon Choi ; Jae Hoon Lee ; Mikel Prieto ; Marco Vivarelli ; Felice Giuliante ; Andrea Ruzzenente ; Chee-Chien Yong ; Safi Dokmak ; Constantino Fondevila ; Mikhail Efanov ; Zenichi Morise ; Fabrizio Di Benedetto ; Raffaele Brustia ; Raffaele Dalla Valle ; Ugo Boggi ; David Geller ; Andrea Belli ; Riccardo Memeo ; Salvatore Gruttadauria ; Alejandro Mejia ; James O Park ; Fernando Rotellar ; Gi-Hong Choi ; Ricardo Robles-Campos ; Xiaoying Wang ; Robert P Sutcliffe ; Johann Pratschke ; Eric C H Lai ; Charing C N Chong ; Mathieu D'Hondt ; Kazuteru Monden ; Santiago Lopez-Ben ; Qu Liu ; Rong Liu ; Alessandro Ferrero ; Giuseppe Maria Ettorre ; Federica Cipriani ; Daniel Cherqui ; Xiao Liang ; Olivier Soubrane ; Go Wakabayashi ; Roberto I Troisi ; Tan-To Cheung ; Yutaro Kato ; Atsushi Sugioka ; Ho-Seong Han ; Tran Cong Duy Long ; David Fuks ; Mohammad Abu Hilal ; Luca Aldrighetti ; Kuo-Hsin Chen ; Bjørn Edwin ; Brian K P Goh
Body Mass Index ; Hepatectomy / methods ; Humans ; Laparoscopy* / methods ; Length of Stay ; Liver Neoplasms* / complications ; Liver Neoplasms* / surgery ; Operative Time ; Postoperative Complications / etiology ; Retrospective Studies ; Treatment Outcome
Keywords
Body mass index ; Laparoscopic hepatectomy ; Laparoscopic liver ; Left lateral sectionectomy ; Minimally-invasive hepatectomy ; Minimally-invasive liver
Abstract
Introduction: Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the perioperative outcomes following laparoscopic left lateral sectionectomy (L-LLS). Methods: A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines. Results: A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5-36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03-1.25), operative time (MD 11 min, 95% CI 6-16), use of Pringles maneuver (RR 1.15, 95% CI 1.06-1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to -0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a "U" shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients. Conclusion: Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections. (c) 2023 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.