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

doi:10.4240/wjgs.v13.i1.19

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World Journal of Gastrointestinal Surgery

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1948-9366

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Retrospective Cohort Study

World J Gastrointest Surg. Jan 27, 2021; 13(1): 19-29
Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.19

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

Daniel Heise, Jan Bednarsch, Andreas Kroh, Sandra Schipper, Roman Eickhoff, Marielle Coolsen, Ronald Van Dam, Sven Lang, Ulf Neumann, Florian Ulmer

Daniel Heise, Jan Bednarsch, Andreas Kroh, Sandra Schipper, Roman Eickhoff, Sven Lang, Ulf Neumann, Florian Ulmer, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany

Marielle Coolsen, Ronald Van Dam, Ulf Neumann, Department of Surgery, Maastricht University Medical Center, Maastricht 6229 HX, Netherlands

Author contributions: Neumann U, Ulmer F, Lang S and Heise D designed the clinical study; Neumann U, Ulmer F, Lang S, Coolsen M, van Dam R and Heise D performed the procedures; Bednarsch J, Kroh A, Schipper S and Eickhoff R obtained and analyzed the data; Heise D, Ulmer F and Bednarsch J wrote the manuscript; all authors have read and approved the final manuscript.

Institutional review board statement: The Institutional Review Board approval was obtained before analysis of the data (EK 423/19).

Informed consent statement: The need for patients’ informed written consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: The authors report that there is no conflict of interest.

Data sharing statement: No additional data are available.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Daniel Heise, MD, Doctor, Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstr 30, Aachen 52074, Germany. dheise@ukaachen.de

Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: October 6, 2020
Revised: October 21, 2020
Accepted: November 28, 2020
Article in press: November 28, 2020
Published online: January 27, 2021
Processing time: 149 Days and 3.5 Hours

ARTICLE HIGHLIGHTS

Research background

Laparoscopic liver surgery is considered the standard of care for various liver malignancies. However, several studies have reported an increased risk of technical difficulties during surgery and the frequent occurrence of postoperative complications in overweight and obese patients.

Research motivation

Studies focusing on perioperative outcome after laparoscopic hepatectomy in overweight patients are still sparse and its benefit compared to open hepatectomy is a matter of debate.

Research objectives

The aim of this study was to analyze postoperative outcomes in overweight (BMI ≥ 25 kg/m²) and obese (BMI ≥ 30 kg/m²) patients undergoing laparoscopic hepatectomy and compare postoperative outcomes with patients undergoing conventional open resection.

Research methods

Perioperative data of 68 overweight and obese patients who underwent laparoscopic hepatectomy at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing open hepatectomy. The postoperative course was reviewed for complications and rated according to the Clavien-Dindo classification and quantified using the Comprehensive Complication Index.

Research results

We provide evidence that overweight patients undergoing laparoscopic hepatectomy have significantly fewer postoperative complications and reduced intensive care stay as well as overall hospitalization without increased overall costs.

Research conclusions

We conclude that laparoscopic hepatectomy is safe and cost-effective in overweight and obese patients. Additionally, this technique is significantly associated with fewer postoperative complications and reduced hospital stay compared to open hepatectomy in these patients.

Research perspectives

Additional research is needed to prospectively confirm our results and to evaluate outcomes in a larger and more balanced cohort to reach a definitive conclusion. Particularly in obese patients with a BMI above 30 kg/m², technical difficulties could be a factor in larger cohorts, which then become apparent.