Liver resection in obese patients: results of a case-control study.
OBJECTIVE
Obesity 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/m(2) ) undergoing LR.


METHODS
85 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.


RESULTS
Operative 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/m(2) ), 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.


CONCLUSIONS
Obese 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.
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France.
Luca
L
Viganò
Michael D
MD
Kluger
Alexis
A
Laurent
Claude
C
Tayar
Jean-Claude
JC
Merle
Jean-Yves
JY
Lauzet
Marion
M
Andreoletti
Daniel
D
Cherqui
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
J Am Coll Surg. 2009 Feb;208(2):210-7
19228532
Ann Surg. 2003 Jul;238(1):29-34
12832962
Lancet. 1997 Mar 22;349(9055):825-32
9121257
Annu Rev Med. 1998;49:215-34
9509260
Lancet. 2003 Jun 14;361(9374):2032-5
12814714
Liver Transpl. 2004 Feb;10(2 Suppl 1):S69-73
14762843
J Gastrointest Surg. 2003 Dec;7(8):1034-44
14675713
Ann Surg. 2007 Jan;245(1):20-30
17197961
J Gastrointest Surg. 1998 May-Jun;2(3):292-8
9841987
Hepatology. 2009 Mar;49(3):851-9
19115377
Arch Surg. 2003 Nov;138(11):1198-206; discussion 1206
14609867
Ann Oncol. 2004 Mar;15(3):460-6
14998849
J Am Coll Surg. 2000 Jul;191(1):38-46
10898182
Ann Surg. 2007 Jun;245(6):923-30
17522518
Ann Intern Med. 1993 Oct 1;119(7 Pt 2):655-60
8363192
Ann Surg. 1999 Jul;230(1):24-30
10400032
Am J Surg. 2000 Apr;179(4):275-81
10875985
Ann Surg. 2004 Oct;240(4):698-708; discussion 708-10
15383797
Ann Surg. 2004 Apr;239(4):433-7
15024302
Ann Surg. 2005 Dec;242(6):824-8, discussion 828-9
16327492
Int J Cardiol. 1995 Nov 10;52(1):23-6
8707431
Lancet. 2007 Feb 10;369(9560):451-2
17297658
World J Gastroenterol. 2008 Mar 14;14(10):1553-8
18330947
Ann Surg. 2009 Jul;250(1):103-11
19561476
Ann Surg. 2004 Aug;240(2):205-13
15273542
Ann Surg. 2001 Sep;234(3):279-89; discussion 289-91
11524581
Ann Surg Oncol. 2008 Aug;15(8):2164-72
18548313
Br J Surg. 1973 Aug;60(8):646-9
4541913
N Engl J Med. 1982 Dec 30;307(27):1661-6
6755254
Hepatology. 2002 Jan;35(1):105-9
11786965
Oncology. 2000 Jun;59(1):18-23
10895061
Br J Surg. 2007 Jan;94(1):58-63
17054316
Br J Surg. 1998 Mar;85(3):355-8
9529492
World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
11234459
Circulation. 1996 Nov 1;94(9 Suppl):II87-92
8901725
Surgery. 1992 Oct;112(4):818-22; discussion 822-3
1411956
Ann Surg. 2009 Nov;250(5):772-82
19801926