Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy

OBJECTIVE To examine the impact of visceral fat on surgical complexity in patients undergoing laparoscopic nephrectomy. PATIENTS AND METHODS We reviewed the medical records of 121 patients who underwent laparoscopic nephrectomy from 2006 to 2010 at our institution. The total fat area, visceral fat area (VFA) and subcutaneous fat area were measured at the level of the umbilicus using computed tomography (CT). To identify the type of obesity, we divided VFA into >= 100 cm(2) and <100 cm(2). A VFA >= 100 cm(2) was used as the definition of visceral obesity. We evaluated the impact of the VFA on technical difficulties encountered during laparoscopic nephrectomy by measuring operating time. RESULTS A significant correlation was observed between body mass index (BMI) and operating time (P < 0.001, r = 0.316) in the patients undergoing laparoscopic nephrectomy. VFA was also significantly correlated with operating time (P < 0.001, r = 0.348), and the correlation coefficient of VFA was higher than that of BMI. Multivariate analysis showed that a high VFA was an independent risk factor for prolonged operating time (P = 0.009, odds ratio; 3.70), whereas BMI was not found to be a risk factor. CONCLUSIONS The present data indicate that measurement of VFA by CT is of benefit for predicting the technical difficulty associated with laparoscopic radical nephrectomy. Visceral obesity, which is one factor involved in metabolic syndrome, has a greater impact than BMI on the complexity of laparoscopic radical nephrectomy.