title: Liver resection in hepatitis B-related hepatocellular carcinoma: clinical outcomes and safety in overweight and obese patients.
abstract: OBJECTIVE
  Although many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample.
  
  
  METHODS
  In a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0-27.9), normal weight(BMI:18.5-23.9) and underweight(BMI<18.5). The Dindo-Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis.
  
  
  RESULTS
  According to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications.
  
  
  CONCLUSIONS
  Liver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Haiqing
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Lunan
authors.initials: L
authors.lastname: Yan
authors.affiliation: Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery* / Q000821:virology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery* / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D016896:Treatment Outcome