Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Obesity is a growing concern in patient populations undergoing surgical procedures.
• Limited data exists on the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese individuals.
• Previous studies on LPN in obese patients are scarce and lack definitive outcomes.

Purpose of the Study:

• To compare the safety and efficacy of LPN in obese versus non-obese patients.
• To provide a comprehensive understanding of LPN outcomes in a select group of obese patients through meta-analysis.

Main Methods:

• A systematic literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Clinicaltrials.gov, Google Scholar).
• Included four observational cohort studies comparing LPN in 256 obese patients and 403 non-obese patients.
• Meta-analysis was performed on extracted data regarding operative parameters, complications, and outcomes.

Main Results:

• No significant differences were observed in operative duration, warm ischemia time, estimated blood loss, or hospital stay between obese and non-obese groups.
• Overall, intraoperative, and postoperative complication rates were comparable between the two groups.
• Obese patients experienced a significantly higher incidence of major (Clavien grade III) complications (4.3% vs 1.5%).

Conclusions:

• Laparoscopic partial nephrectomy can be safely and effectively performed in obese patients by experienced surgeons, yielding comparable results to non-obese patients.
• While overall complication rates are similar, the risk of major complications (Clavien Classification ≥ III) is elevated in the obese patient cohort.
• Further research may be warranted to explore strategies for mitigating major complications in obese patients undergoing LPN.