Gabriela M Vargas, MD, MS1, Eric P Sieloff, BSc2, Abhishek D Parmar, MD, MS3, Nina P Tamirisa, MD3, Taylor S Riall, MD, PhD2. 1LSU Health Shreveport and University of Texas Medical Branch, 2University of Texas Medical Branch, 3University of Texas Medical Branch and UCSF-East Bay
INTRODUCTION: While there are many reported advantages to laparoscopic rectal surgery when compared to open rectal surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery is not well understood. Our goal was to evaluate the use of laparoscopic rectal surgery in obese patients and determine if obese patients experienced the same benefits as non-obese patients.
METHODS: We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project (NSQIP) participant use data file. Multivariable logistic regression modeling demonstrated an interaction between BMI and laparoscopy on the development of complications. As a result, we performed stratified multivariable analyses in both obese (BMI > 30 kg/m2) and non-obese patients (BMI < 30 kg/m2) to determine the independent effects of laparoscopy on complications for each group separately.
RESULTS: 24,045 patients underwent rectal resection. The mean age was 58.1 years, 32.7% were obese, and 43.6% had cancer. Laparoscopic procedures were less common in obese patients compared to non-obese (39.4% vs. 42%, p<0.0001). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9% vs. 31.6%, p<0.0001) and non-obese (15.6% vs. 23.6%, p<0.0001) patients. Likewise, length of stay was lower with laparoscopy in both obese (mean=5.8 vs. 8.7 days, p<0.0001) and non-obese (mean=6.0 vs. 8.5 days, p<0.0001) patients. In a multivariable analysis controlling for patient demographics, comorbidity, ASA class, and presence of a diverting stoma, non-obese patients undergoing laparoscopic surgery had 32% lower odds of developing postoperative complications compared to open surgery (OR 0.68, 95% CI 0.62-0.74). This benefit was even greater for obese patients (OR 0.59, 95% CI 0.52-0.66).
CONCLUSION: Laparoscopic pelvic surgery is associated with fewer complications when compared to open pelvic surgery in both obese and non-obese patients. Given the increased risk of postoperative morbidity with increasing BMI, minimally invasive rectal surgery may be of greater benefit to the obese patient.