The evidence for the safety and potential advantages of minimally invasive liver surgery (MILS) in obese individuals is scant, despite the global rise in both obesity and the use of MILS. For a study, researchers sought to examine the results of non-obese and obese patients (BMI 18.5-29.9 and BMI≥30, respectively) receiving MILS and OLS, as well as to determine trends in MILS use among obese patients, they compared the outcomes of both groups of patients.
The characteristics and outcomes of non-obese and obese patients were compared in the retrospective cohort analysis, which comprised patients treated at 20 hospitals across eight different countries between 2009 and 2019. Following propensity-score matching (PSM), the results of MILS and OLS were compared across both groups. Investigations were made into modifications made to MILS adoption over the research period.
There were 9,963 patients in all (MILS: 4,687; OLS: 5,276). Obese patients (n = 1,977) were more commonly comorbid, got less preoperative chemotherapy or had a history of prior hepatectomy, had longer operation durations and greater intraoperative blood loss (IOBL), and had considerably higher rates of wound- and respiratory-related problems compared to non-obese patients (n = 7,986). MILS was linked with fewer IOBL (200 ml vs 320 ml, 200 ml vs 400 ml, respectively), reduced rates of transfusions (6.6% vs 12.8%, 4.7% vs 14.7%), complications (26.1% vs 35%, 24.9% vs 34%), bile leaks (4% vs 7%, 1.8% vs 4.9%), liver failure (0.7% vs 2.3% 0.2% vs 2.1%), & a shorter length of stay(5 vs 7 & 4 vs 7 days). Despite a steady rise in surgical complexity, a careful application of MILS in obese patients (42.1%-53%, P<.001) was accompanied by consistent severe morbidity (P =.433) and fatality (P =.423) rates.
MILS became more popular and had been linked to perioperative advantages in both non-obese and obese patients.
Reference: sciencedirect.com/science/article/pii/S1743919122007348
