Laparoscopic staged adjustable gastric banding and liver resection in morbidly obese patient

Should bariatric surgery be offered for hepatocellular adenomas in obese patients?

BACKGROUND

Obesity and metabolic syndrome are increasingly recognized as risk factors for development of hepatocellular adenoma (HCA). The implications of weight loss on HCA regression has not been previously reviewed.

OBJECTIVES

To analyze the effects of surgical and nonsurgical weight loss on HCA.

SETTING

University Tertiary Hospital.

METHODS

Literature review of full-text articles from PubMed and Scopus on patients with HCA who underwent surgical or nonsurgical weight loss was performed. Only English language articles were included and editorial comments were excluded. Wilcoxon signed rank test was used for paired data analysis. Spearman correlation was used for correlation between percent excess weight loss (%EWL) and number and size of HCA lesions.

RESULTS

Out of 4 studies, 7 patients were included in this review, all of whom were female. The median preintervention body mass index was 41 kg/m² compared with the postintervention body mass index of 28 kg/m² (P = .002). The %EWL following intervention positively correlated to reduction in number of HCA lesions (%) postintervention, with a Spearman correlation of .78 (P = .04). Similarly, %EWL postintervention was positively correlated, though not statistically significant, to reduction in lesion size (%), with a Spearman correlation of .46 (P = .29). All patients who were candidates for liver resection preintervention based on lesion size > 5 cm avoided liver resection postintervention following surgical and nonsurgical weight loss.

CONCLUSIONS

Effective long-term weight loss by surgical and nonsurgical methods result in regression of HCAs. Weight loss could avoid major liver resections or decrease the morbidity associated with liver surgery. Bariatric surgery should be considered as an option for management of surgically challenging HCAs in carefully selected obese patients. Multicenter long-term trials, while adjusting for cofounding factors, are required to determine the effects of surgical compared with nonsurgical weight loss on maintenance of HCA regression.

Two-staged surgery for metastatic liver tumor in morbidly obese individual-left hemihepatectomy following placement of laparoscopic adjustable gastric band

A 47-year-old male with a body mass index (BMI) 37.12 kg/m(2) was diagnosed with an ill-demarcated tumor within IVB segment of left lobe of the liver. Sixteen months earlier, he underwent laparoscopic gastric banding for morbid obesity (BMI 51 kg/m(2)). One year after bariatric procedure, he was diagnosed with rectal adenocarcinoma. Following abdominoperineal resection of rectum with total mesorectal excision and 2 months course of adjuvant FOLFOX chemotherapy, he was scheduled for liver resection. Left hemihepatectomy was performed with no major complications; wound discharge was successfully treated in outpatient clinic. Twelve months following surgery, he remains disease free with no evidence of local recurrence, metachronic primary tumor, or distant metastases. This is first to our knowledge report providing data on the outcome of left hemihepatectomy performed in postbariatric patient. The role of bariatric surgery and utilization of the time necessary for neoadjuvant chemotherapy to reduce the excessive body mass and the degree of liver steatosis is discussed.