Influence of body mass index on complications and oncologic outcomes following hepatectomy for malignancy

Amit Mathur, Amir A. Ghaferi, Kristen Sell, Christopher J. Sonnenday, Michael J. Englesbe, Theodore H. Welling

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown. Methods: Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996-2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival. Results: Seventy-nine patients (28.3%) had primary hepatobiliary cancers, 134 (48.0%) had colorectal metastases, and 66 (25.3%) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8% vs. 15.9%, p = 0.018), bile leaks (18.6% vs. 9.9%, p = 0.030), post-operative pneumonia (9.3% vs. 2.2%, p = 0.0074), intra-abdominal abscesses (7.2% vs. 1.7%, p = 0.017), acute renal failure (7.2% vs. 1.7%, p = 0. 017), urinary tract infections (16.4% vs. 7.7%, p = 0.024), and longer lengths of stay (10.5 vs. 8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95% CI 0.86-0.95) and overall survival (HR 0.96, 95% CI 0.92-0.99). Conclusions: High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.

Original languageEnglish (US)
Pages (from-to)849-857
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number5
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Hepatectomy
Body Mass Index
Neoplasms
Recurrence
Survival
Liver
Neoplasm Metastasis
Abdominal Abscess
Proportional Hazards Models
Acute Kidney Injury
Urinary Tract Infections
Bile
Length of Stay
Pneumonia
Demography
Morbidity
Mortality

Keywords

  • Body mass index
  • Hepatectomy
  • Hepatic malignancy
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Influence of body mass index on complications and oncologic outcomes following hepatectomy for malignancy. / Mathur, Amit; Ghaferi, Amir A.; Sell, Kristen; Sonnenday, Christopher J.; Englesbe, Michael J.; Welling, Theodore H.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 5, 2010, p. 849-857.

Research output: Contribution to journalArticle

Mathur, Amit ; Ghaferi, Amir A. ; Sell, Kristen ; Sonnenday, Christopher J. ; Englesbe, Michael J. ; Welling, Theodore H. / Influence of body mass index on complications and oncologic outcomes following hepatectomy for malignancy. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 5. pp. 849-857.
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abstract = "Background: Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown. Methods: Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996-2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival. Results: Seventy-nine patients (28.3{\%}) had primary hepatobiliary cancers, 134 (48.0{\%}) had colorectal metastases, and 66 (25.3{\%}) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8{\%} vs. 15.9{\%}, p = 0.018), bile leaks (18.6{\%} vs. 9.9{\%}, p = 0.030), post-operative pneumonia (9.3{\%} vs. 2.2{\%}, p = 0.0074), intra-abdominal abscesses (7.2{\%} vs. 1.7{\%}, p = 0.017), acute renal failure (7.2{\%} vs. 1.7{\%}, p = 0. 017), urinary tract infections (16.4{\%} vs. 7.7{\%}, p = 0.024), and longer lengths of stay (10.5 vs. 8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95{\%} CI 0.86-0.95) and overall survival (HR 0.96, 95{\%} CI 0.92-0.99). Conclusions: High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.",
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T1 - Influence of body mass index on complications and oncologic outcomes following hepatectomy for malignancy

AU - Mathur, Amit

AU - Ghaferi, Amir A.

AU - Sell, Kristen

AU - Sonnenday, Christopher J.

AU - Englesbe, Michael J.

AU - Welling, Theodore H.

PY - 2010

Y1 - 2010

N2 - Background: Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown. Methods: Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996-2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival. Results: Seventy-nine patients (28.3%) had primary hepatobiliary cancers, 134 (48.0%) had colorectal metastases, and 66 (25.3%) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8% vs. 15.9%, p = 0.018), bile leaks (18.6% vs. 9.9%, p = 0.030), post-operative pneumonia (9.3% vs. 2.2%, p = 0.0074), intra-abdominal abscesses (7.2% vs. 1.7%, p = 0.017), acute renal failure (7.2% vs. 1.7%, p = 0. 017), urinary tract infections (16.4% vs. 7.7%, p = 0.024), and longer lengths of stay (10.5 vs. 8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95% CI 0.86-0.95) and overall survival (HR 0.96, 95% CI 0.92-0.99). Conclusions: High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.

AB - Background: Following hepatectomy for malignancy, the effect of body mass index (BMI) on hepatic and oncologic outcomes is unknown. Methods: Two hundred seventy-nine post-hepatectomy patients with malignancy from our center were included in the cohort (1996-2006). BMI was categorized using World Health Organization criteria. The effect of BMI was evaluated using risk-adjusted Cox models for time to recurrence and overall survival. Results: Seventy-nine patients (28.3%) had primary hepatobiliary cancers, 134 (48.0%) had colorectal metastases, and 66 (25.3%) had other metastases. Thirty-five percent of patients were obese (BMI > 30). Obese patients had more hepatic-specific perioperative complications (27.8% vs. 15.9%, p = 0.018), bile leaks (18.6% vs. 9.9%, p = 0.030), post-operative pneumonia (9.3% vs. 2.2%, p = 0.0074), intra-abdominal abscesses (7.2% vs. 1.7%, p = 0.017), acute renal failure (7.2% vs. 1.7%, p = 0. 017), urinary tract infections (16.4% vs. 7.7%, p = 0.024), and longer lengths of stay (10.5 vs. 8.6 days, p = 0.029). Obese and non-obese patients had similar perioperative mortality, time to recurrence, and overall survival on univariate analysis. However, after adjusting for demographic, tumor, and operative characteristics, and complications, increasing BMI displayed improved recurrence-free (HR 0.90, 95% CI 0.86-0.95) and overall survival (HR 0.96, 95% CI 0.92-0.99). Conclusions: High BMI patients may have better oncologic outcomes despite higher perioperative morbidity and hepatic complications following hepatectomy. These findings have important clinical and biological implications.

KW - Body mass index

KW - Hepatectomy

KW - Hepatic malignancy

KW - Recurrence

KW - Survival

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