Liver and Multiorgan Transplant Unit, University of Bologna, Bologna, Italy.
Br J Surg. 2011 Aug;98(8):1147-54. doi: 10.1002/bjs.7516. Epub 2011 Apr 20.
The simultaneous incremental increase in incidence of both obesity and hepatocellular carcinoma (HCC) will soon lead to more overweight and obese patients with cirrhosis needing surgery. At present, little is known about postoperative mortality and morbidity in such patients. This study investigated outcomes after hepatectomy in relation to obesity in a homogeneous cohort of patients with cirrhosis.
Perioperative data from 235 patients with cirrhosis who had hepatectomy for HCC were related to the presence of normal bodyweight (body mass index (BMI) 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI at least 30 kg/m(2)). Complications after surgery were graded according to the expanded Accordion Severity Classification of Postoperative Complications (T92).
One hundred and one patients (43.0 per cent) were of normal bodyweight, 88 (37.4 per cent) were overweight and 46 (19.6 per cent) were obese; none was underweight. Overweight and obese groups showed a male preponderance (P = 0.024), and metabolic disorders were frequently the cause of cirrhosis in these patients (P < 0.001 and P = 0.014 for non-B non-C hepatitis and alcoholic cirrhosis respectively). Liver function tests, tumour stage and extent of hepatectomy did not significantly differ between BMI groups. The intraoperative course and postoperative mortality were unaffected by BMI. Overweight and obese patients had significantly more mild respiratory complications (P = 0.044). Severe complications and organ system (including liver) failure were not significantly affected by BMI.
Hepatic resection can be performed safely in overweight and obese patients with cirrhosis, although morbidity is increased in these patients.
肥胖和肝细胞癌（HCC）发病率的同时递增，很快将导致更多超重和肥胖的肝硬化患者需要接受手术。目前，对于此类患者术后死亡率和发病率知之甚少。本研究调查了肥胖与肝硬化患者肝切除术后结果的关系。
将 235 例因 HCC 接受肝切除术的肝硬化患者的围手术期数据与正常体重（体重指数（BMI）18.5-24.9kg/m2）、超重（BMI 25.0-29.9kg/m2）和肥胖（BMI 至少 30kg/m2）的存在相关联。根据扩展的 Accordion 术后并发症严重程度分类（T92）对手术后并发症进行分级。
101 例（43.0%）患者为正常体重，88 例（37.4%）患者超重，46 例（19.6%）患者肥胖，无体重不足患者。超重和肥胖组显示男性优势（P=0.024），并且这些患者的肝硬化常由代谢紊乱引起（非 B 非 C 型肝炎和酒精性肝硬化分别为 P<0.001 和 P=0.014）。BMI 组之间的肝功能检查、肿瘤分期和肝切除范围无显著差异。手术过程和术后死亡率不受 BMI 影响。超重和肥胖患者的轻度呼吸并发症明显更多（P=0.044）。严重并发症和多器官系统（包括肝脏）衰竭不受 BMI 影响。
超重和肥胖的肝硬化患者可以安全地进行肝切除术，但这些患者的发病率增加。
