Impact of obesity on postoperative outcome of hepatic resection for colorectal metastases

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• 作者：Serena Langella ; MD ; ^{slangella@mauriziano.it" class="auth_mail" title="E-mail the corresponding author} ; Nadia Russolillo ; MD ; Fabio Forchino ; MD ; Roberto Lo Tesoriere ; MD ; Marco D'Eletto ; MD ; Alessandro Ferrero ; MD
• 刊名：Surgery
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：158
• 期：6
• 页码：1521-1529
• 全文大小：270 K

文摘

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.

Study design

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/m²) 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).

Conclusion

Obese patients undergoing hepatectomy for colorectal metastases should be approached with caution because of an increased risk of postoperative morbidity.