Assessment of Factors Associated with Morbidity and Textbook Outcomes of Laparoscopic Liver Resection in Obese Patients: A French Nationwide Study.
Résumé
BACKGROUND: Liver surgeons need to know the expected outcomes of laparoscopic liver resection (LLR) in obese patients. OBJECTIVE: To assess morbidity, mortality and textbook outcomes (TO) after LLR in obese patients. METHODS: This is a French multicenter study of patients undergoing LLR between 1996 and 2018. Obesity was defined by a body mass index ≥q 30\,kg/m². Short-term outcomes and textbook outcomes were compared between obese (ob) and non-obese (non-ob) patients. Factors associated with severe morbidity and TO were investigated. RESULTS: Of 3154 patients included, 616 (19.5%) were obese. Ob-group patients had significantly higher ASA score and higher incidence of metabolic syndrome and chronic liver disease, and were less likely to undergo major hepatectomy. Mortality rates were similar between ob and non-ob groups (0.8 vs. 1.1%; p=0.66). Overall morbidity and hospital stay were significantly increased in the ob group compared to the non-ob group (39.4 vs. 34.7%; p=0.03, and 9.5 vs. 8.6 days; p=0.02) whereas severe 90-day morbidity (≥q Clavien-Dindo grade III) was similar between groups (8% in both groups; p=0.90). TO rate was significantly lower the ob group than the non-ob group (58.3 vs. 63.7%; p=0.01). In multivariate analysis, obesity did not emerge as a risk factor for severe 90-day morbidity but was associated with a lower TO rate after LLR (odd ratio=0.8, 95% confidence interval=0.7-1.0; p=0.03). CONCLUSIONS: LLR in obese patients is safe and effective with acceptable mortality and morbidity. Obesity had no impact on severe morbidity but was a factor for failing to achieve TO after LLR.