The Impact Of Obesity On Perioperative Outcomes In Laparoscopic Radical Nephrectomy: A Systematic Review And Meta-analysis

Objective:Controversy exists regarding the safety and efficiency of laparoscopic radical nephrectomy(LRN)on morbid obese patients and the difference of perioperative outcomes between the obese and non-obese patients.This study aims to assess the association of obesity on perioperative outcomes in LRN.Materials and Methods:We conducted a systemic review and meta-analysis to clarify the relationship.Relevant studies were searched in nine databases,PubMed,Web of Science,Embase,Cochrane Library,Wiley Online Library,SpringerLink,Elsevier,EBSCO,and Ovid.Database searching was updated until Feb 2017.Mesh search headings with combining keywords were searched about obese and non-obese patients who undergone LRN.References in all the inclusions were also searched.Data extraction and study quality assessment were conducted by canonical methods.Results:9 retrospective studies were included with a total of 1039 patients.The results demonstrated that:(1)obese group were compared with non-obese group with a longer operation duration(American p<0.00001,WMD: 49.21 min,95 %CI: 35.97 to 62.45;Asian p<0.00001,WMD: 26.94 min,95 % CI: 19.04 to 34.85;overall WMD: 32.80 min,95 % CI: 26.01 to 39.58,p<0.00001)and a larger estimated blood loss(American p=0.03,WMD: 34.02 ml,95 % CI: 3.95 to 64.09;Asian p<0.00001,WMD: 49.61 ml,95% CI: 42.32 to 56.91;overall WMD: 48.75 ml,95% CI: 41.66 to 55.83,p<0.00001),with significant statistical difference;(2)the two groups showed no significant statistical difference in blood transfusion rate(American p=0.27,Asian p=0.27),length of stay(American p=0.37,Asian p=0.87),conversion to open operation rate(American p=0.27,Asian p=0.11),total complication rates(American p=0.89,Asian p=0.07),major and minor complication rates(major complication rates p=0.97,minor complication rates p=0.54),time until oral intake resumption(American p=0.94,Asian p=0.72),time to ambulation(American p=0.14,Asian p=0.42).Conclusions:Although the perioperative outcomes of obese patients who undergo laparoscopic radical nephrectomy demonstrated larger EBL and longer OD in comparison of those of non-obese groups,it still could be performed for obese patients safely and efficiently.