Liver resection in obese patients: results of a case-control study |
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Authors: | Viganò Luca Kluger Michael D Laurent Alexis Tayar Claude Merle Jean-Claude Lauzet Jean-Yves Andreoletti Marion Cherqui Daniel |
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Institution: | 1Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France;2Department of Anesthesiology, Henri Mondor Hospital, Creteil, France |
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Abstract: | ObjectivesObesity has been associated with worse postoperative outcomes. No data are available regarding short-term results after liver resection (LR). The aim of this study was to analyse outcomes in obese patients (body mass index BMI] > 30 kg/m2) undergoing LR.Methods85 consecutive obese patients undergoing LR between 1998 and 2008 were matched on a ratio of 1:2 with 170 non-obese patients. Matching criteria were diagnosis, ASA score, METAVIR fibrosis score, extent of LR, and Child–Pugh score in patients with cirrhosis.ResultsOperative time, blood loss and blood transfusions were similar in the two groups. Mortality was 2.4% in both groups. Morbidity was significantly higher in the obese group (32.9% vs. 21.2%; P= 0.041). However, only grade II morbidity was increased in obese patients (14.1% vs. 1.8%; P < 0.001) and this was mainly related to abdominal wall complications (8.2% vs. 2.4%; P= 0.046). No differences were encountered in terms of grade III or IV morbidity. The same results were observed in major LR and cirrhotic patients. When patients were stratified by BMI (<20, 20–25, 25–30 and >30 kg/m2), progressive increases in overall and infectious morbidity were observed (5.6%, 22.4%, 23.7%, 32.9%, and 5.6%, 11.8%, 14.5%, 18.8%, respectively). Rates of grade III and IV morbidity did not change.DiscussionObese patients have increased postoperative morbidity after LR in comparison with non-obese patients, but this is mainly related to minor abdominal wall complications. Severe morbidity rates and mortality are similar to those in non-obese patients, even in cirrhosis or after major LR. |
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Keywords: | liver surgery liver resection obesity BMI case-control study steatosis ASA score morbidity postoperative outcomes laparoscopic liver surgery cirrhosis |
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