Department of Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.
Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7, Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
Obes Surg. 2022 Aug;32(8):2672-2681. doi: 10.1007/s11695-022-06125-6. Epub 2022 Jun 13.
This study aimed to provide reference values for the percentage total weight loss during 1 year after laparoscopic sleeve gastrectomy associated with primary response in Japan.
This multicenter retrospective study comprised 248 patients with severe obesity who underwent laparoscopic sleeve gastrectomy at five institutions in Japan. A percentage total weight loss < 20% at 1 year was defined as primary non-response. Parsimonious predictive models were developed based on the results of multiple regression analyses. A receiver operating characteristic curve analysis was used to assess the discriminative performance for primary non-response.
The median age, initial body mass index, and percentage total weight loss at 1 year were 41 years, 41.4 kg/m, and 30.1%, respectively. There were 28 (11.3%) primary non-responders. For discriminating primary non-responders, the areas under the receiver operating characteristic curve of the parsimonious model and actual percentage of total weight loss at 3 months after laparoscopic sleeve gastrectomy were 0.846 and 0.803, respectively. Cutoffs for the predicted percentage total weight loss using the model and actual value of percentage total weight loss at 3 months attaining 80% sensitivity were 30% and 22%, and those attaining 98% specificity were 22% and 15%, respectively.
Reference values for the percentage total weight loss at 3 months were obtained using the predictive model and actual value of percentage total weight loss at 3 months. Patients at risk for primary non-response can be determined at 3 months with these values, which can help in considering earlier interventions.
本研究旨在为日本腹腔镜袖状胃切除术（LSG）后 1 年内总减重百分比与原发性应答相关的参考值提供依据。
本多中心回顾性研究纳入了在日本五家机构接受腹腔镜袖状胃切除术的 248 例严重肥胖患者。1 年内总减重百分比＜20%定义为原发性无应答。基于多元回归分析的结果，建立了简约预测模型。使用受试者工作特征曲线分析评估原发性无应答的判别性能。
中位年龄、初始体重指数和 1 年时的总减重百分比分别为 41 岁、41.4kg/m2和 30.1%。有 28 例（11.3%）患者为原发性无应答者。对于鉴别原发性无应答者，简约模型和腹腔镜袖状胃切除术后 3 个月实际总减重百分比的受试者工作特征曲线下面积分别为 0.846 和 0.803。使用模型预测的总减重百分比和达到 80%敏感性的 3 个月实际总减重百分比的截断值分别为 30%和 22%，达到 98%特异性的截断值分别为 22%和 15%。
通过预测模型和腹腔镜袖状胃切除术后 3 个月的实际总减重百分比获得了 3 个月总减重百分比的参考值。可以使用这些值在 3 个月时确定原发性无应答的风险患者，这有助于考虑早期干预。
