Heise Daniel, Bednarsch Jan, Kroh Andreas, Schipper Sandra, Eickhoff Roman, Coolsen Marielle, Van Dam Ronald, Lang Sven, Neumann Ulf, Ulmer Florian
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen 52074, Germany.
Department of Surgery, Maastricht University Medical Center, Maastricht 6229 HX, Netherlands.
World J Gastrointest Surg. 2021 Jan 27;13(1):19-29. doi: 10.4240/wjgs.v13.i1.19.
Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.
To analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m²] and obese (BMI over 30 kg/m²) patients undergoing LH and compare postoperative outcome with patients undergoing OH.
Perioperative data of 68 overweight (BMI over 25 kg/m²) including a subcohort of obese (BMI over 30 kg/m²) patients ( = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.
The mean BMI was 29.8 ± 4.9 kg/m in the LH group and 29.7 ± 3.6 kg/m in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 ± 88 min 275 ± 131 min; < 0.001) as well as intensive care (0.8 ± 0.7 d 1.1 ± 0.8 d; = 0.031) and hospital stay (7.3 ± 3.6 d 15.7 ± 13.5 d; < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% 45.6%; = 0.005) and major complications (1.5% 14.7%, = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH ( = 27) and OH ( = 29) showed a shorter operative time (194 ± 81 min 260 ± 137 min; = 0.009) and a reduced length of hospitalization (7.7 ± 4.3 d 17.2 ± 17 d; < 0.001) but no difference in postoperative complications or overall cost.
LH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.
腹腔镜肝手术目前被认为是各种肝脏恶性肿瘤的治疗标准。然而，针对超重患者腹腔镜肝切除术（LH）围手术期结果的研究仍然较少，与开腹肝切除术（OH）相比，其益处仍存在争议。
分析超重[体重指数（BMI）超过25kg/m²]和肥胖（BMI超过30kg/m²）患者接受LH后的术后结果，并将术后结果与接受OH的患者进行比较。
回顾性分析了2015年至2019年在我院接受LH的68例超重（BMI超过25kg/m²）患者，其中包括一个肥胖（BMI超过30kg/m²）患者亚组（n = 27）的手术结果，并与同等数量接受OH的患者进行比较。
LH组的平均BMI为29.8±4.9kg/m²，OH组为29.7±3.6kg/m²，分别有20.6%（LH）和26.5%（OH）的病例进行了大手术。LH组的手术时间（194±88分钟对275±131分钟；P<0.001）、重症监护时间（0.8±0.7天对1.1±0.8天；P = 0.031）和住院时间（7.3±3.6天对15.7±13.5天；P<0.001）明显更短。此外，LH术后总体并发症（20.6%对与45.6%；P = 0.005）和严重并发症（1.5%对14.7%，P = 0.002）的发生率也更低。对接受LH（n = 27）和OH（n = 29）的肥胖患者亚组进行的另一项分析显示，手术时间更短（194±81分钟对260±137分钟；P = 0.009），住院时间缩短（7.7±4.3天对17.2±17天；P<0.001），但术后并发症或总体费用没有差异。
LH在超重和肥胖患者中是安全且具有成本效益的。此外，与OH相比，LH在这些患者中与更少的术后并发症和缩短的住院时间显著相关。
