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

What's known on the subject? and What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta‐analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non‐obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and s from conference proceedings without language restriction for studies comparing LPN in obese and non‐obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non‐obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]–3.80 to 15.09), warm ischaemic time (MD –1.04, 95% CI –2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72–106.74) or hospital stay (MD –0.04, 95% CI –0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70–1.49), intraoperative complications (OR 0.68, 95% CI 0.30–1.53), or postoperative complications (OR 1.15, 95% CI 0.75–1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36–11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non‐obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non‐obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.