Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study

Abstract

Obesity is known as a risk factor for intra- and postoperative complications in pancreatic operation. However, the operative outcomes in obese patients undergoing laparoscopic distal pancreatectomy remain unclear. A total number of 423 patients underwent laparoscopic distal pancreatectomy at Oslo University Hospital-Rikshospitalet from April 1997 to December 2015. Patients were categorized into 3 groups based on the body mass index: normal weight (18.5-24.9kg/m2), overweight (25-29.9kg/m2), and obese (≥30kg/m2). After excluding underweight patients, 402 patients were enrolled in this study. Obese patients had significantly longer operative time and increased blood loss compared with overweight and normal weight patients (190 [61-480] minutes vs 158 [56-520] minutes vs 153 [29-374] minutes, P=.009 and 200 [0-2,800] mL vs 50 [0-6250] mL vs 90 [0-2,000] mL, P=.01, respectively). A multiple linear regression analysis identified obesity as predictive of prolonged operative time and increased blood loss during laparoscopic distal pancreatectomy. The rates of clinically relevant pancreatic fistula and severe complications (≥grade III by Accordion classification) were comparable in the 3 groups (P=.23 and P=.37, respectively). A multivariate logistic regression model did not demonstrate an association between obesity and postoperative morbidity (P=.09). The duration of hospital stay was comparable in the 3 groups (P=.13). In spite of longer operative time and greater blood loss, laparoscopic distal pancreatectomy in obese patients is associated with satisfactory postoperative outcomes, similar to those in normal weight and overweight patients. Hence, laparoscopic distal pancreatectomy should be equally considered both in obese and nonobese patients.