Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients

H. Daniel; J. Bednarsch; A. Kroh; S. Schipper; R. Eickhoff; M. Coolsen; R. Van Dam; S. Lang; U. Neumann; F. Ulmer

doi:10.4240/wjgs.v13.i1.19

Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients

H. Daniel^*, J. Bednarsch, A. Kroh, S. Schipper, R. Eickhoff, M. Coolsen, R. Van Dam, S. Lang, U. Neumann, F. Ulmer

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND

Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.

AIM

To analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m(2)] and obese (BMI over 30 kg/m(2)) patients undergoing LH and compare postoperative outcome with patients undergoing OH.

METHODS

Perioperative data of 68 overweight (BMI over 25 kg/m(2)) including a subcohort of obese (BMI over 30 kg/m(2)) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.

RESULTS

The mean BMI was 29.8 +/- 4.9 kg/m(2) in the LH group and 29.7 +/- 3.6 kg/m(2) in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 +/- 88 min vs 275 +/- 131 min; P < 0.001) as well as intensive care (0.8 +/- 0.7 d vs 1.1 +/- 0.8 d; P = 0.031) and hospital stay (7.3 +/- 3.6 d vs 15.7 +/- 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 +/- 81 min vs 260 +/- 137 min; P = 0.009) and a reduced length of hospitalization (7.7 +/- 4.3 d vs 17.2 +/- 17 d; P < 0.001) but no difference in postoperative complications or overall cost.

CONCLUSION

LH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

Original language	English
Pages (from-to)	19-29
Number of pages	11
Journal	World Journal of Gastrointestinal Surgery
Volume	13
Issue number	1
DOIs	https://doi.org/10.4240/wjgs.v13.i1.19
Publication status	Published - 27 Jan 2021

Keywords

body-mass index
cancer
cost
hepatic resection
impact
laparoscopic hepatectomy
liver resection
morbidity
obesity
outcomes
overweight
postoperative outcome
surgical complications
technical feasibility
Laparoscopic hepatectomy
Cost
CANCER
Postoperative outcome
Overweight
SURGICAL COMPLICATIONS
TECHNICAL FEASIBILITY
Obesity
HEPATIC RESECTION
Morbidity
IMPACT
LIVER RESECTION
BODY-MASS INDEX
OUTCOMES

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Cite this

@article{ef6c503e857e430fa041326f31757cd7,

title = "Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients",

abstract = "BACKGROUNDLaparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.AIMTo analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m(2)] and obese (BMI over 30 kg/m(2)) patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODSPerioperative data of 68 overweight (BMI over 25 kg/m(2)) including a subcohort of obese (BMI over 30 kg/m(2)) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTSThe mean BMI was 29.8 +/- 4.9 kg/m(2) in the LH group and 29.7 +/- 3.6 kg/m(2) in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 +/- 88 min vs 275 +/- 131 min; P < 0.001) as well as intensive care (0.8 +/- 0.7 d vs 1.1 +/- 0.8 d; P = 0.031) and hospital stay (7.3 +/- 3.6 d vs 15.7 +/- 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 +/- 81 min vs 260 +/- 137 min; P = 0.009) and a reduced length of hospitalization (7.7 +/- 4.3 d vs 17.2 +/- 17 d; P < 0.001) but no difference in postoperative complications or overall cost.CONCLUSIONLH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.",

keywords = "body-mass index, cancer, cost, hepatic resection, impact, laparoscopic hepatectomy, liver resection, morbidity, obesity, outcomes, overweight, postoperative outcome, surgical complications, technical feasibility, Laparoscopic hepatectomy, Cost, CANCER, Postoperative outcome, Overweight, SURGICAL COMPLICATIONS, TECHNICAL FEASIBILITY, Obesity, HEPATIC RESECTION, Morbidity, IMPACT, LIVER RESECTION, BODY-MASS INDEX, OUTCOMES",

author = "H. Daniel and J. Bednarsch and A. Kroh and S. Schipper and R. Eickhoff and M. Coolsen and {Van Dam}, R. and S. Lang and U. Neumann and F. Ulmer",

year = "2021",

month = jan,

day = "27",

doi = "10.4240/wjgs.v13.i1.19",

language = "English",

volume = "13",

pages = "19--29",

journal = "World Journal of Gastrointestinal Surgery",

issn = "1948-9366",

publisher = "Baishideng Publishing Group",

number = "1",

}

TY - JOUR

T1 - Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients

AU - Daniel, H.

AU - Bednarsch, J.

AU - Kroh, A.

AU - Schipper, S.

AU - Eickhoff, R.

AU - Coolsen, M.

AU - Van Dam, R.

AU - Lang, S.

AU - Neumann, U.

AU - Ulmer, F.

PY - 2021/1/27

Y1 - 2021/1/27

N2 - BACKGROUNDLaparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.AIMTo analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m(2)] and obese (BMI over 30 kg/m(2)) patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODSPerioperative data of 68 overweight (BMI over 25 kg/m(2)) including a subcohort of obese (BMI over 30 kg/m(2)) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTSThe mean BMI was 29.8 +/- 4.9 kg/m(2) in the LH group and 29.7 +/- 3.6 kg/m(2) in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 +/- 88 min vs 275 +/- 131 min; P < 0.001) as well as intensive care (0.8 +/- 0.7 d vs 1.1 +/- 0.8 d; P = 0.031) and hospital stay (7.3 +/- 3.6 d vs 15.7 +/- 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 +/- 81 min vs 260 +/- 137 min; P = 0.009) and a reduced length of hospitalization (7.7 +/- 4.3 d vs 17.2 +/- 17 d; P < 0.001) but no difference in postoperative complications or overall cost.CONCLUSIONLH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

AB - BACKGROUNDLaparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.AIMTo analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m(2)] and obese (BMI over 30 kg/m(2)) patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODSPerioperative data of 68 overweight (BMI over 25 kg/m(2)) including a subcohort of obese (BMI over 30 kg/m(2)) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTSThe mean BMI was 29.8 +/- 4.9 kg/m(2) in the LH group and 29.7 +/- 3.6 kg/m(2) in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 +/- 88 min vs 275 +/- 131 min; P < 0.001) as well as intensive care (0.8 +/- 0.7 d vs 1.1 +/- 0.8 d; P = 0.031) and hospital stay (7.3 +/- 3.6 d vs 15.7 +/- 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 +/- 81 min vs 260 +/- 137 min; P = 0.009) and a reduced length of hospitalization (7.7 +/- 4.3 d vs 17.2 +/- 17 d; P < 0.001) but no difference in postoperative complications or overall cost.CONCLUSIONLH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

KW - body-mass index

KW - cancer

KW - cost

KW - hepatic resection

KW - impact

KW - laparoscopic hepatectomy

KW - liver resection

KW - morbidity

KW - obesity

KW - outcomes

KW - overweight

KW - postoperative outcome

KW - surgical complications

KW - technical feasibility

KW - Laparoscopic hepatectomy

KW - Cost

KW - CANCER

KW - Postoperative outcome

KW - Overweight

KW - SURGICAL COMPLICATIONS

KW - TECHNICAL FEASIBILITY

KW - Obesity

KW - HEPATIC RESECTION

KW - Morbidity

KW - IMPACT

KW - LIVER RESECTION

KW - BODY-MASS INDEX

KW - OUTCOMES

U2 - 10.4240/wjgs.v13.i1.19

DO - 10.4240/wjgs.v13.i1.19

M3 - Article

C2 - 33552392

SN - 1948-9366

VL - 13

SP - 19

EP - 29

JO - World Journal of Gastrointestinal Surgery

JF - World Journal of Gastrointestinal Surgery

IS - 1

ER -