Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry
Authors: Guerrera Francesco , Lyberis Paraskevas , Lausi Paolo Olivo , Cristofori Riccardo Carlo , Giobbe Roberto , Molinatti Massimo , Filosso Pier Luigi , Curcio Carlo , Crisci Roberto , Ruffini Enrico ,   on the behalf of the Italian VATS Group, Maurizio Mancuso , Fausto Pernazza , Majed Refai , Franco Stella , Desideria Argnani , Giuseppe Marulli , Angela De Palma , Luigi Bortolotti , Giovanna Rizzardi , Piergiorgio Solli , Giampiero Dolci , Reinhold Perkmann , Francesco Zaraca , Roberto Benvenuti Mauro , Diego Gavezzoli , Roberto Cherchi , Albino Ferrari Paolo , Felice Mucilli , Pierpaolo Camplese , Giulio Melloni , Federico Mazza , Giorgio Cavallesco , Pio Maniscalco , Luca Voltolini , Alessandro Gonfiotti , Francesco Sollitto , Pia Ardò Nicoletta , Luca Pariscenti Gian , Carlo Risso , Corrado Surrente , Camillo Lopez , Andrea Droghetti , Michele Giovanardi , Cristiano Breda , Fabio Lo Giudice , Marco Alloisio , Edoardo Bottoni , Lorenzo Spaggiari , Roberto Gasparri , Massimo Torre , Alessandro Rinaldo , Mario Nosotti , Davide Tosi , Giampeiro Negri , Alessandro Bandiera , Alessandro Baisi , Federico Raveglia , Alessandro Stefani , Pamela Natali , Marco Scarci , Emanuele Pirondini , Carlo Curcio , Dario Amore , Ottavio Rena , Samuele Nicotra , Andrea Dell’ Amore , Alessandro Bertani , Giorgia Tancredi , Luca Ampollini , Paolo Carbognani , Francesco Puma , Damiano Vinci , Giuseppe Cardillo , Francesco Carleo , Stefano Margaritora , Elisa Meacci , Piero Paladini , Marco Ghisalberti , Roberto Crisci , Duilio Divisi , Diego Fontana , Vittorio Della Beffa , Angelo Morelli , Francesco Londero , Andrea Imperatori , Nicola Rotolo , Alberto  , Andrea Viti , Maurizio Infante , Cristiano Benato 
Published: August 2021

Abstract
Objectives
Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry.

Methods
The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity.

Results
From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%).

Conclusion
Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.