Abstract
Objective and BackgroundAlthough many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample.MethodsIn a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0–27.9), normal weight(BMI:18.5–23.9) and underweight(BMI<18.5). The Dindo–Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis.ResultsAccording to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications.ConclusionsLiver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.
Highlights
Liver resection remains one of the most common and effective treatments for hepatocellular carcinoma(HCC) and has become a widely accepted therapy method[1]
The surgeons are facing with new challenge deriving from the longer and more difficult surgeries for obese and overweight patients[2]
Overweight(6.3% vs 2.5%,P,0.001) and obese patient(11.0% vs 2.5%,P = 0.001) had more wound complication than the normal weight patients
Summary
Liver resection remains one of the most common and effective treatments for hepatocellular carcinoma(HCC) and has become a widely accepted therapy method[1]. With the refinement of surgical techniques and perioperative management in liver surgery over the past several decades, outcomes after liver resection have improved substantially in recent years. With the prevalence of obesity continuously increasing worldwide, obesity and overweight are an increasing public health problem. In the United States[3], 66.2% of adults were obese or overweight in 2003–2004 year. There is a much lower prevalence of obesity and overweight in China than in other parts of the world, the condition has increased dramatically during recent decades[4,5]. Obesity in Chinese adults, according to criteria from the Working Group on Obesity in China (WGOC) criteria, increased during the period from 1993 to 2009, from 2.9% to
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