Comparison of Minimally Invasive vs Open Hepatectomy in Obese Patients
Overview
This meta-analysis of 11 studies including 1,713 obese patients with liver tumors found that minimally invasive hepatectomy (MIH) is associated with shorter operative time, less blood loss, lower transfusion rates, fewer complications, and shorter hospital stays compared to open hepatectomy (OH). Mortality rates did not differ significantly between the two approaches.
Background
Obesity is a growing global health concern linked to increased postoperative complications and cancer risk. Liver resection in obese patients is challenging due to adipose tissue accumulation and inflammation. Minimally invasive hepatectomy techniques, including laparoscopic and robotic approaches, offer enhanced visualization and precision but their safety and efficacy in obese patients remain uncertain. This study systematically compares surgical outcomes of MIH versus OH in this population.
Data Highlights
Outcome
Effect Size (MIH vs OH)
95% CI
P-value
Operative time (minutes)
−54.50
−96.28 to −12.72
0.01
Blood loss (mL)
−416.80
−579.84 to −253.76
<0.00001
Blood transfusion rate (OR)
0.31
0.19–0.48
<0.00001
Overall complications (OR)
0.60
0.48–0.75
<0.0001
Major complications (OR)
0.61
0.42–0.89
0.01
Biliary leakage (OR)
0.48
0.26–0.88
0.02
Liver failure (OR)
0.26
0.08–0.93
0.04
Postoperative hospital stay (days)
−7.21
−10.22 to −4.21
<0.00001
Tumor size (cm)
−1.06
−1.70 to −0.41
0.001
Mortality (OR)
0.68
0.45–1.03
0.07
Key Findings
MIH significantly reduces operative time by approximately 54 minutes compared to OH in obese patients.
Blood loss during MIH is substantially lower by over 400 mL, with a corresponding decrease in blood transfusion rates.
MIH is associated with significantly fewer overall and major postoperative complications, including biliary leakage and liver failure.
Patients undergoing MIH have a shorter postoperative hospital stay by over 7 days.
Tumor sizes were smaller in the MIH group, though mortality rates did not differ significantly between MIH and OH.
Clinical Implications
Minimally invasive hepatectomy offers a safer and more effective surgical option for obese patients with liver tumors, reducing operative risks and enhancing recovery. Surgeons should consider MIH techniques to minimize blood loss and postoperative complications in this high-risk population. However, careful patient selection and surgical expertise remain essential given the technical challenges posed by obesity.
Conclusion
MIH provides significant perioperative advantages over OH in obese patients with liver tumors without increasing mortality risk, supporting its use as a preferred surgical approach in this group.
