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THE IMPACT OF BMI ON PERIOPERATIVE OUTCOMES AFTER ROBOTIC LIVER RESECTION Aviad Gravetz, Iswanto Sucandy, Chandler Wilfong, Janelle Spence, Timothy J. Bourdeau*, Sharona Ross, Alexander Rosemurgy Florida Hospital Tampa, Tampa, FL Introduction: High body mass index (BMI) is associated with many factors which can impact perioperative outcomes after liver resection. Higher BMI is more associated with non-alcoholic fatty liver disease, steatosis, and cirrhosis. Higher BMI is also more often seen with comorbidities such as hypertension, COPD, diabetes, GERD, chronic cholecystitis, and hypercholesterolemia. This study was undertaken to determine the impact of BMI on perioperative outcomes after robotic liver resection. Methods: With IRB approval, 38 consecutive patients undergoing robotic liver resection in a single-center were prospectively followed and analyzed. Patient demographic data, preoperative data, operative procedure, operative time, estimated blood loss (EBL), perioperative complications, and postoperative length of stay (LOS) were collected and analyzed. Interval data were analyzed utilizing regression analysis. Data, where appropriate, are presented as median (mean ± SD). Results: Of 38 patients undergoing robotic hepatectomy, 73% were women, of age 58 (57±17.6) years, BMI 29 (30±8.5) kg/m2, and ASA class 3 (3 ±0.5). Indications included neoplastic lesions in 34 patients (89%), hemangioma in 2 patients (6%), fibrous tissue in 1 patient (2.5%), and focal nodular hyperplasia in 1 patient (2.5%). 32% of patients underwent formal right or left hemihepatectomy, 21% underwent formal sectionectomy, 5% underwent central hepatectomy and the remaining 16 patients underwent non-anatomic liver resection involving at least one segment. Overall, operative time was 261 (254.6±94.3) min and EBL 175 (276±294.8) mL with six patients requiring blood transfusions generally because of preoperative anemia of chronic disease. LOS was 3 (5±4.9) days. By regression analysis, operative time, EBL, and LOS did not have a significant relationship with BMI (p=0.28, p=0.11, and p=0.09 respectively). Twelve patients (32%) experienced a preoperative complication not associated with BMI (p=0.09): 10 of 12 were not specific to liver resection (e.g., cardiorespiratory in 3, renal dysfunction in 3, urinary retention in 2) and 2 were a consequence of liver resection (1 hematoma, 1 bile leak). Conclusion: Obesity should not dissuade surgeons from utilizing minimally invasive robotic liver resection. Obesity was not associated with notable operative time, EBL, or morbidity. Robotic liver resection is safe, feasible, and efficacious independent of BMI and is the preferred approach for obese patients requiring liver resection.
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