Liver resection in obesity patients
Kenei Furukawa
, Koichiro Haruki, Tomohiko Taniai, Mitsuru Yanagaki, Toru Ikegami
Keywords: Liver resection; colorectal liver metastases (CRLM); obesity
Submitted Nov 19, 2024. Accepted for publication Dec 11, 2024. Published online Jan 15, 2025.
doi: 10.21037/hbsn-2024-657
We enjoyed the article by Kampf et al. (1) on obesity and its association with fatty liver and post-hepatectomy liver failure (PHLF). They concluded that obesity, defined by body mass index (BMI), was associated with liver steatosis and fibrosis; however, postoperative complications, including PHLF after liver resection, were comparable regardless of BMI, suggesting that liver resection is safely performed in obese patients. However, the surgical method for obese patients is also important, and Inoue et al. have reported that open liver resection for colorectal liver metastases (CRLM) in obese patients resulted in a significantly higher risk of infectious complications than laparoscopic liver resection (2).
As the authors mentioned in the limitations section, obesity was assessed using BMI in this study, but other assessments (waist circumference and body composition) need to be considered. Moreover, fatty liver was assessed by pathological evaluation of the resected liver specimens, which cannot be assessed preoperatively.
We conducted the analyses in 167 patients who underwent hepatectomy for CRLM at our institute between May 2007 and December 2021. BMI was the most useful assessment for diagnosing fatty liver by preoperative computed tomography (CT) (3) (Table 1). Therefore, we are in favor of assessing obesity using the BMI, which is widely available and easy to evaluate.
Table 1
| Variables | AUC | P value |
|---|---|---|
| BMI | 0.793 | <0.01 |
| Waist circumference | 0.779 | <0.01 |
| SFA | 0.692 | <0.01 |
| VFA | 0.785 | <0.01 |
| VFA/SFA ratio | 0.570 | 0.30 |
AUC, area under the curve; BMI, body mass index; SFA, subcutaneous fat area; VFA, visceral fat area.
Although obesity appears to be associated with a higher risk of postoperative complications after liver surgery, there is no consensus regarding its effect on long-term outcomes. Generally, postoperative complications contribute to poor long-term outcomes (4). However, some studies have reported the protective effects of obesity on long-term outcomes (5,6). In our cohort, among the various obesity assessments, only high waist circumference was a significantly favorable prognostic factor for overall survival (Table 2).
Table 2
| Variables | OS univariate analysis | |
|---|---|---|
| Hazard ratio (95% CI) | P value | |
| BMI, high | 0.71 (0.36–1.40) | 0.32 |
| Waist circumference, high | 0.58 (0.35–0.96) | 0.04 |
| SFA, high | 0.96 (0.58–1.57) | 0.86 |
| VFA, high | 1.02 (0.62–1.67) | 0.95 |
| VFA/SFA ratio | 1.11 (0.67–1.84) | 0.68 |
OS, overall survival; CI, confidence interval; BMI, body mass index; SFA, subcutaneous fat area; VFA, visceral fat area.
As the rate of obesity increases worldwide, it is important to consider liver resection in patients with obesity. In addition, we should return to the basics and reaffirm the importance of evaluating obesity based on BMI and waist circumference, which do not require special testing equipment, rather than body composition using CT and body composition analyzers.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, HepatoBiliary Surgery and Nutrition. The article did not undergo external peer review.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2024-657/coif). The authors have no conflicts of interest to declare.
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References
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