Comparison of robotic liver resection in obese vs. non-obese patients: a multicentric propensity score-matched analysis of perioperative outcomes

Obesity poses unique challenges in liver surgery, potentially affecting perioperative outcomes. While laparoscopic liver resection (LLR) has demonstrated clear benefits over open surgery, evidence regarding the impact of body mass index (BMI) on robotic liver resection (RLR) outcomes remains limited. This study aims to evaluate the influence of BMI on perioperative outcomes following RLR. A retrospective, multicenter analysis was conducted on patients undergoing RLR. A 3:1 propensity score matching (PSM) was performed to minimize confounding factors, creating two well-balanced groups: patients with BMI <30 and BMI ≥30. Perioperative outcomes, including operative time, blood loss, conversion rates, postoperative complications and R0 resection were compared between the two groups. After PSM, 472 patients were included (BMI <30: n = 354; BMI ≥30: n = 118). No significant differences were observed in operative time (244 ± 107 min vs. 256±120 min, p=0.271), blood loss (225 ± 254 mL vs. 201 ± 186 mL, p = 0.273), or conversion rates (4.5 vs. 3.4%, p=0.601). Overall postoperative complications were comparable between the two groups (14.4% vs.19.5%, p=0.203). ICU stay and hospital length of stay were similar between groups. R0 resection rate was comparable between the groups (95.4 vs. 95.4%, p = 1.000). The 90-day mortality rate was low in both groups (0.3 vs. 0%, p = 0.987). Our findings suggest that RLR is a safe and effective approach for patients regardless of BMI. Despite concerns regarding surgical complexity in obese patients, the robotic approach provides comparable perioperative outcomes in both obese and non-obese patients.