title: Impact of obesity on postoperative outcome of hepatic resection for colorectal metastases.
abstract: BACKGROUND
  Outcomes in obese patients who underwent liver resection have been analyzed, but series are heterogeneous and data are controversial. The aim of this study was to analyze short-outcome in obese patients undergone hepatectomy for colorectal metastases.
  
  
  METHODS
  A retrospective analysis on 1,021 consecutive hepatectomies between January 2000 and April 2014 for colorectal metastases was carried out. World Health Organization Classification of obesity (body mass index >30 kg/m(2)) was used to identify 140 obese patients. Outcomes were compared among obese and nonobese patients.
  
  
  RESULTS
  Obese patients were mainly male (78%) and were associated more frequently with hypertension (51% vs 29%, P < .001), ischemic heart disease (9% vs 3%, P = .007), and diabetes (23% vs 10%, P < .001) compared with nonobese patients. Approximately 30% of patients underwent major hepatectomy in the 2 groups. Associated resections were performed in 36% of obese and 37% of nonobese patients. Median parenchymal transection time (80 ± 64 minutes vs 70 ± 50 minutes, P = .013) and blood loss (300 ± 420 vs 200 ± 282, P = .001) were greater in obese patients. Postoperative mortality was nil in obese patients and 0.6% in nonobese patients. Overall morbidity was greater in obese patients (41% vs 31%, P = .012) mainly related to pulmonary complications (16% vs 9%, P = .012). Reinterventions were more frequent in obese patients (3.6% vs 1.2%, P = .004). Median hospital stay was comparable. At pathologic examination, hepatic steatosis was greater in obese (69% vs 43%, P < .001). At multivariate analysis, age >65 years (odds ratio [OR] 1.43, 95% confidence interval [95% CI] 1.09-1.88), obesity (OR 1.64, 95% CI 1.13-2.38), major hepatectomies (OR 1.65, 95% CI 1.31-2.33), and associated resections (OR 1.67, I95% CI 1.27-2.20) were independent predictors of overall morbidity (P < .001). Among obese patients, there was a positive correlation between age and severity of complications (R = 0.173, P = .041).
  
  
  CONCLUSIONS
  Obese patients undergoing hepatectomy for colorectal metastases should be approached with caution because of an increased risk of postoperative morbidity.
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy. Electronic address: slangella@mauriziano.it.
authors: Serena
authors: S
authors: Langella
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy.
authors: Nadia
authors: N
authors: Russolillo
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy.
authors: Fabio
authors: F
authors: Forchino
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy.
authors: Roberto
authors: R
authors: Lo Tesoriere
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy.
authors: Marco
authors: M
authors: D'Eletto
authors: Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy.
authors: Alessandro
authors: A
authors: Ferrero
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015179:Colorectal Neoplasms / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome