Darren W Chua1,2, Nicholas Syn1,3, Ye-Xin Koh1,2,4, Jin-Yao Teo1,2, Peng-Chung Cheow1,2,4, Alexander Y F Chung1,2,4, Chung-Yip Chan1,2,4, Brian K P Goh5,6,7. 1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore. 2. Duke-National University of Singapore Medical School, Singapore, Singapore. 3. Ministry of Health Holdings, Singapore, Singapore. 4. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore. 5. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Level 5, 20 College Road, Singapore, 169856, Singapore. bsgkp@hotmail.com. 6. Duke-National University of Singapore Medical School, Singapore, Singapore. bsgkp@hotmail.com. 7. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore. bsgkp@hotmail.com.
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.
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.
Authors: M C Halls; G Berardi; F Cipriani; L Barkhatov; P Lainas; S Harris; M D'Hondt; F Rotellar; I Dagher; L Aldrighetti; R I Troisi; B Edwin; M Abu Hilal Journal: Br J Surg Date: 2018-05-08 Impact factor: 6.939
Authors: Brian K P Goh; Nicholas Syn; Jin-Yao Teo; Yu-Xin Guo; Ser-Yee Lee; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan Journal: World J Surg Date: 2019-03 Impact factor: 3.352
Authors: Brian K P Goh; Nicholas Syn; Ser-Yee Lee; Ye-Xin Koh; Jin-Yao Teo; Juinn-Huar Kam; Peng-Chung Cheow; Prema-Raj Jeyaraj; Pierce K Chow; London L Ooi; Alexander Y Chung; Chung-Yip Chan Journal: Surg Endosc Date: 2020-09-24 Impact factor: 4.584