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Association of standardized liver volume and body mass index with outcomes of minimally invasive liver resections

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Abstract

Introduction

While minimally invasive liver resections (MILR) have demonstrated advantages in improved post-operative recovery, widespread adoption is hampered by inherent technical difficulties. Our study attempts to analyze the role of anthropometric measures in MILR-related outcomes.

Methods

Between 2012 and 2020, 676 consecutive patients underwent MILR at the Singapore General Hospital of which 565 met study criteria and were included. Patients were stratified based on Body Mass Index (BMI) as well as Standardized Liver Volumes (SLV). Associations between BMI and SLV to selected peri-operative outcomes were analyzed using restricted cubic splines.

Results

A BMI of ≥ 29 was associated with increase in blood loss [Mean difference (MD) 69 mls, 95% CI 2 to 137] as well as operative conversions [Relative Risk (RR) 1.63, 95% CI 1.02 to 2.62] among patients undergoing MILR while a SLV of 1600 cc or higher was associated with an increase in blood loss (MD 30 mls, 95% CI 10 to 49). In addition, a BMI of ≤ 20 was associated with an increased risk of major complications (RR 2.25, 95% 1.16 to 4.35). The magnitude of differences observed in these findings increased with each unit change in BMI and SLV.

Conclusion

Both BMI and SLV were useful anthropometric measures in predicting peri-operative outcomes in MILR and may be considered for incorporation in future difficulty scoring systems for MILR.

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Authors and Affiliations

  1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore

    Darren W. Chua, Nicholas Syn, Ye-Xin Koh, Jin-Yao Teo, Peng-Chung Cheow, Alexander Y. F. Chung, Chung-Yip Chan & Brian K. P. Goh

  2. Duke-National University of Singapore Medical School, Singapore, Singapore

    Darren W. Chua, Ye-Xin Koh, Jin-Yao Teo, Peng-Chung Cheow, Alexander Y. F. Chung, Chung-Yip Chan & Brian K. P. Goh

  3. Ministry of Health Holdings, Singapore, Singapore

    Nicholas Syn

  4. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore

    Ye-Xin Koh, Peng-Chung Cheow, Alexander Y. F. Chung, Chung-Yip Chan & Brian K. P. Goh

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  1. Darren W. Chua
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Correspondence to Brian K. P. Goh.

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The authors indicated in this manuscript: Darren Chua Weiquan, Nicholas Syn, Ye Xin Koh, Jin Yao Teo, Peng Chung Cheow, Alexander Chung, Chung Yip Chan and Brian Goh have no disclosures to make.

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Chua, D.W., Syn, N., Koh, YX. et al. Association of standardized liver volume and body mass index with outcomes of minimally invasive liver resections. Surg Endosc 37, 456–465 (2023). https://doi.org/10.1007/s00464-022-09534-x

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