Obesity Alters the Pharmacokinetics of Vincristine in Mice.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1636-1636
Author(s):  
James W Behan ◽  
Vassilios I Avramis ◽  
Jason P Yun ◽  
Anna Butturini ◽  
Steven D Mittelman
Keyword(s):  
Body Weight ◽  
Specific Activity ◽  
Scintillation Counter ◽  
Compartment Model ◽  
Blood Levels ◽  
Obese Patients ◽  
Obese Mice ◽  
Time Points ◽  
Poor Outcome ◽  
Increased Risk

Abstract Obesity has been associated with increased risk of development and poor outcome from a variety of hematological malignancies. There is a lack of consensus as to how to dose chemotherapies in obese patients, and therefore inadequate dosing represents a potential factor contributing to poor outcome. We have previously shown that diet-induced obese mice transplanted with p190BCR/ABL ALL cells and then treated with vincristine (VCR) proportional to body weight (15 mg/kg/wk × 4 wks) have a poorer outcome than non-obese mice (event free survival: Obese = 0.42, Control = 0.75, p=0.07, log rank). The present study was designed to quantify the pharmacokinetic (PK) parameters of vincristine in control and obese mice and determine whether differences in these parameters could explain the poorer outcome in the obese mice. Twenty obese and 20 control mice received tail-vein injections of tritiated vincristine (specific activity 75 mCi/mg; dose 0.5 mg/kg). Blood samples were taken at 5 minutes, and the mice sacrificed at various time-points between 15 minutes and 24 hours post-injection. Whole blood and tissue specimens were solubilized, decolorized, and read on a scintillation counter. Blood vincristine concentrations were fit to a 3-compartment model using the two-stage PK in 3 subsets of VCR concentrations vs. time method. Non-compartmental modeling was used to confirm the results. Due to body weight differences, obese mice received ~ 28% more vincristine per injection than controls. Blood vincristine concentrations in both groups of animals followed a triexponential decay, as has been previously described. Blood levels tended to be higher (by 20±15%) in the obese mice at all time-points tested. While the t1/2α was longer in the obese mice (10.6 vs. 6.0 minutes), the t1/2b and t1/2γ were both shorter (22.7 vs. 27.1 minutes and 114.4 vs. 345.8 hours). Therefore the AUC0 → 24 was higher in the obese mice (3,279 vs. 2,776 ng/ml*hr), while the AUC0 → ∞ was lower in the obese mice (21,705 vs. 53,581 ng/ml*hr). Vincristine concentrations in spleen and bone marrow were similar at all time-points in the obese and control groups. In summary, obesity caused alterations in vincristine pharmacokinetics, characterized by longer initial half-life but shorter terminal half-lives. Thus, it is possible that the decreased AUC0 → ∞ contributed to the poorer outcome in this model. Despite this, blood and tissue concentrations of vincristine were equal or higher in the obese mice during the first 24 hours after injection of the drug when it was dosed proportional to body weight. These data suggest that dosing vincristine in obese patients based on body surface may lead to lower levels in blood and tissue, particularly if the dose is capped. As the prevalence of obesity continues to increase, pharmacokinetics studies should be performed in obese and lean subjects to further optimize chemotherapy dosing regimens in obese patients.

The influence of obesity on hydroxychloroquine blood levels in lupus nephritis patients

Lupus ◽  
2021 ◽  
pp. 096120332098521
Author(s):  
Tatiana Pedrosa ◽  
Léonard de Vinci Kanda Kupa ◽  
Sandra Gofinet Pasoto ◽  
Nádia Emi Aikawa ◽  
Eduardo Ferreira Borba ◽  
...  
Keyword(s):  
Body Weight ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Blood Levels ◽  
Concomitant Treatment ◽  
Obese Patients ◽  
Maximum Daily Dose ◽  
Increased Risk ◽  
Daily Dose ◽  
The Impact

Introduction In 2016 the American Academy of Ophthalmology(2016-AAO) recommended a maximum daily HCQ use of 5.0 mg/kg real body weight(RBW) taking into consideration minimizing eye toxicity. Retinopathy in systemic lupus erythematosus(SLE) patients was recently associated with obesity and this condition is progressively more common in these patients. However, the impact of obesity in HCQ blood levels remains controversial. Objective To determine if the 2016-AAO recommendation based on RBW with and without maximum daily dose restriction results in adequate and safe blood levels in obese lupus nephritis(LN) patients. Methods A cross-sectional study was performed with 108 LN patients under the prescribed 2016-AAO dose for at least 3 months. LN patients were assessed for demographic characteristics, body mass index(BMI), disease parameters, HCQ dose, concomitant treatment and HCQ blood levels measured by liquid chromatography-tandem mass spectrometry. Obesity was defined as BMI ≥30kg/m2. Results Obesity was identified in 35/108(32%) LN patients. The calculation of HCQ daily dosage revealed that obese patients were under a lower prescribed daily dose according to the real body weight (RBW) [4.4(2.9-5.4) vs. 4.9(4-5.5)mg/Kg/day, p < 0.001] due to the maximum limit used. Regardless of that the median of HCQ blood levels was significantly higher in obese compared to non-obese patients (1562 ± 548.6 vs. 1208 ± 448.9 ng/mL, p = 0.002). Further analysis of patients under the 20016-AAO recommendation by RBW without the restriction of maximum daily dose confirmed that in spite of comparable daily dose in 14 obese patients and 61 non-obese patients [4.8 (4.5-5.4) vs. 5.0(4.5-5.5) mg/kg, p = 0.312], the median of HCQ blood levels was significantly higher in obese patients than in non-obese (1734 ± 457.3 vs. 1189 ± 449.4 ng/mL, p < 0.001). Conclusion Obese patients under the 2016-AAO prescribed dose of HCQ based on RBW with and without maximum daily dose restriction have a very high HCQ blood levels compared to non-obese patients, with a potential increased risk of ocular toxicity. The use of 2016-AAO dose of HCQ according to the ideal body weight for this group of patients should be considered.Clinicaltrials.gov #NCT0312243.

scholarly journals High Bodyweight Variability Increases Depression Risk in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study in Korea

2021 ◽  
Vol 12 ◽  
Author(s):  
Ji Hyun An ◽  
Kyung-do Han ◽  
Jin-Hyung Jung ◽  
Juhwan Yoo ◽  
Maurizio Fava ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
Obese Patients ◽  
Type 2 Dm ◽  
Increased Risk ◽  
Quartile Group ◽  
New Onset

Objectives: Although obesity is associated with increased risk for depression in patients with type 2 diabetes mellitus (DM), the relationship between body weight variability (BWV) and depression remains poorly studied. This study was to investigate the incidence of depression in patients with type 2 DM according to their BWV.Methods: Intraindividual variation in body weight were measured in the nationwide, population-based retrospective cohort of 540,293 patients with type 2 DM from the Korean national health insurance system between 2009 and 2010. The diagnoses of new-onset depression occurring until the end of 2017 were ascertained. Risk of new-onset depression was examined using multivariate-adjusted Cox proportional hazards regression analysis by BWV quartile.Results: 93,149 (17.2%) patients developed new-onset depression for the follow up. BWV was significantly associated with an increased risk of depression after adjusting for confounding factors. The highest BWV quartile group had a hazard ratio (HR) of 1.17 (95% CI 1.15–1.19) compared to the lowest BWV quartile group as a reference. Obese patients in the highest BWV quartile group showed 12% increased risk of depression (HR 1.12, 95% CI 1.09–1.15) while non-obese patients in the highest BWV quartile group showed 20% increased risk of depression (HR: 1.20, 95% CI: 1.17–1.23) compared to their respective lowest BWV quartile groups.Conclusion: A higher BWV was significantly associated with an increased risk of depression in patients with type 2 DM. Thus, BWV may serve as an indicator for early detection of depression in type 2 DM patients.

Abstract 4448: Clopidogrel Effect Depends on Body Weight and Abolishes Platelet Leukocyte Interaction in Patients with Coronary Artery Disease Treated by Stenting

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Philipp Diehl ◽  
Christoph Olivier ◽  
Christoph Halscheid ◽  
Thomas Helbing ◽  
Christoph Bode ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Weight ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Obese Patients ◽  
Platelet Activity ◽  
Impedance Aggregometry ◽  
Increased Risk ◽  
Leukocyte Counts ◽  
Artery Disease

Background: Poor response to aspirin and clopidogrel has been associated with an increased risk for thrombotic events after PCI. The optimal dose of clopidogrel is unknown as platelet aggregability (PA) is not routinely measured in clopidogrel treated patients. Methods and Results : In order to assess potential mechanisms of clopidogrel responsiveness we have performed bedside platelet impedance aggregometry in patients with stable coronary artery disease (group CAD; n=62) and patients who underwent elective PCI (group PCI; n=90) compared to control individuals in whom coronary artery disease was excluded by coronary angiography (group control; n=28). Control patients did not receive antiplatelet therapy, CAD patients were treated with aspirin 100mg/d, and PCI patients with aspirin 100mg/d and clopidogrel 75mg/d. Impedance aggregometry was performed using arachidonic acid [AA] (final conc [fc]: 0.5mM) or ADP (fc: 6.5μM) and the area under the curve (AUC) was quantified to detect the effect of aspirin or clopidogrel, respectively. Indeed, PA was specifically reduced by either drug (AA: [control vs. CAD vs. PCI] 877±300 vs. 183±134 vs. 111±90; ADP: [control vs. PCI] 725±275 vs. 288±174 AUC). We detected a negative correlation between body weight and clopidogrel response (r=0.28; p=0.008), suggesting that clopidogrel may have been underdosed in obese patients. Furthermore, we found a positive correlation between leukocyte counts and PA (r=0.4, p=0.028) confirming that platelets and leucocytes interact functionally. Administration of clopidogrel abolished this interaction as detected by comparison of control individuals with PCI patients but also in intra-individual follow-up tests before and after introduction of clopidogrel. Conclusion: Impedance aggregometry is useful to assess PA routinely. Dosage of clopidogrel may need to be adjusted in obese patients. PA depends on leukocyte counts confirming that platelet activity is modulated by leukocytes; this interaction is effectively inhibited by clopidogrel.

Obesity and Body Weight Independently Predict Relapse and Survival in Preadolescents and Teenagers with Acute Lymphoblastic Leukemia (ALL). A Retrospective Analysis of Five Children Cancer Group (CCG) Studies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 992-992 ◽  
Author(s):  
Anna Butturini ◽  
Fred Dorey ◽  
Paul Gaynon ◽  
Cecilia Fu ◽  
Janet Franklin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Body Weight ◽  
Lymphoblastic Leukemia ◽  
Obese Patients ◽  
Event Free Survival ◽  
Free Survival ◽  
Cancer Group ◽  
Control Growth ◽  
Increased Risk ◽  
Leukemia Relapse

Abstract We analyzed data from 4356 patients with ALL diagnosed from 1988 to 1995 at age 2–20 years and enrolled in CCG studies 1881, 1891, 1922, 1882 or 1901. Patients with Down Syndrome and those with CNS disease at diagnosis were excluded. Obesity was defined as a body mass index (BMI)>95th percentile by the Center for Disease Control growth charts (www.cdc.gov/growthcharts). Obesity at diagnosis did not affect outcome in patients younger than 10 years but independently predicted 5y risk of leukemia relapse and event free survival (EFS) in the 1026 patients aged 10 years or older. Multivariate analysis in patients aged 10 years or older showed that obese patients had increased risk of leukemia relapse (hazard ratio-HR- 1.5, p=0.013) and of all the events (HR 1.5, p=0.009). Other independent predictors of poor outcome were high WBC at diagnosis and failure to achieve bone marrow M1 status by day 7 of therapy. Age had borderline significance; sex, race and type of therapy were not significant. To assess whether the effect of obesity on outcome was due to absolute body weight, we studied the effect of weight in Kg at diagnosis in patients aged 10 years or older. Patients >60kg had increased risk of leukemia relapse (HR 1.4, p=0.002) and of all the events (HR 1.4, p=0.006). High WBC at diagnosis and bone marrow status at day 7 maintained their significance; age, sex, race and therapy were not significant. The effects of obesity and weight on outcome only partially overlapped: obesity still predicted outcome when only patients <60 kg were analyzed as well as weight >60 kg predicted outcome when obese patients were excluded from the analysis. Obesity and weight >60 kg at diagnosis were not associated with differences in early toxic deaths, lenght of initial phases of therapy or days of hospitalization. In conclusion, preadolescents and teenagers with ALL who were either obese or >60 kg of weight at diagnosis had higher risk of leukemia relapse and poorer EFS.

Oral and Dermal Pharmacokinetics of Triclopyr in Human Volunteers

1989 ◽  
Vol 8 (6) ◽  
pp. 431-437 ◽  
Author(s):  
N.G. Carmichael ◽  
R.J. Nolan ◽  
J.M. Perkins ◽  
R. Davies ◽  
S.J. Warrington
Keyword(s):  
Body Weight ◽  
Oral Administration ◽  
Time Course ◽  
Compartment Model ◽  
Dermal Absorption ◽  
Blood Levels ◽  
Human Volunteers ◽  
Applied Dose ◽  
Dermal Pharmacokinetics ◽  
Oral Doses

Blood levels and urinary excretion of triclopyr, the active ingredient in Garlon® herbicides, were followed in six volunteers given single oral doses of 0.1 and 0.5 mg/kg body weight. Five of these volunteers later received dermal applications of Garlon 4 herbicide formulation equivlant to 3.7 mg triclopyr/kg body weight applied to the forearm. Following oral administration blood levels peaked at 2-3 h and declined to undetectable levels within 48 h; more than 80% of. the dose was found as unchanged triclopyr in the urine. A two-compartment pharmacokinetic model was used to describe the time-course of triclopyr clearance; half-lives for the rapid initial and slower terminal phases were 1.3 h and 5.1 h respectively, and were independent of dose. Due to the slow half-life for dermal absorption (t½ = 16.8 h) the rapid initial elimination phase was obscured and the pharmacokinetics could be simplified by a one-compartment model. An average of 1.37% of the applied dose was recovered in the urine; when corrected for recovery after oral administration this was equivalent to an absorption of 1.65%. Triclopyr is slowly absorbed through skin and is rapidly eliminated. It has very low potential to accumulate in man or to be absorbed through the skin in acutely toxic amounts.

Obesity is not strongly associated with increased risk for febrile neutropenia during levofloxacin prophylaxis in patients with hematological malignancies receiving intermediate-risk myelosuppressive chemotherapy

2019 ◽  
Vol 26 (6) ◽  
pp. 1301-1305
Author(s):  
Amanda Kurtti ◽  
Kelly Fritz ◽  
Kathryn Elofson-Disney ◽  
Russell Benefield
Keyword(s):  
Body Weight ◽  
Febrile Neutropenia ◽  
Creatinine Clearance ◽  
Antibacterial Prophylaxis ◽  
Intermediate Risk ◽  
Obese Patients ◽  
Time Curve ◽  
Myelosuppressive Chemotherapy ◽  
Concentration Time ◽  
Increased Risk

Levofloxacin given at a standard dose of 500 mg daily is recommended for antibacterial prophylaxis in patients receiving myelosuppressive chemotherapy. Obese patients have been shown to exhibit enhanced clearance of levofloxacin and may be at risk for prophylactic failure. This single center, retrospective cohort study from June 2014 to May 2017 evaluated adult patients with estimated creatinine clearance ≥50 mL/min receiving their first cycle of a National Comprehensive Cancer Network defined intermediate-risk regimen. Primary endpoint was incidence of febrile neutropenia. Secondary endpoints included 30-day mortality and the correlation between estimated levofloxacin area under the concentration–time curve and rates of febrile neutropenia. Febrile neutropenia occurred in 26 patients: 12 (35.3%) obese and 14 (21.9%) non-obese ( P =  0.16). Six (23.1%) of these patients required intensive care, but there were no deaths within 30 days of a febrile neutropenia event. Estimated creatinine clearance was similar between obese and non-obese patients (median 97.5 vs. 91.8 mL/min, P =  0.39), as was estimated levofloxacin area under the concentration–time curve (median 85.6 vs. 90.8 mg×h/L, P =  0.39). There were no significant associations between body weight-related variables – total body weight (median 83.4 vs. 80.6 kg, P =  0.51), body mass index (mean 29.6 vs. 26.8 kg/m2, P =  0.35), or body surface area (1.98 vs. 1.99 m2, P =  0.68) – and febrile neutropenia in this cohort of patients with similar renal function. Obesity should not be a justification for more aggressive levofloxacin dosing schemes when used for febrile neutropenia prophylaxis.

scholarly journals AB0871 OSTEOARTHRITIS IN OBESE PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1741.1-1742
Author(s):  
S. Lapshina ◽  
L. Feiskhanova ◽  
A. Nurmieva ◽  
K. Sadriev
Keyword(s):  
Metabolic Syndrome ◽  
Body Weight ◽  
Normal Weight ◽  
Knee Joints ◽  
Excess Body Weight ◽  
Obese Patients ◽  
Obese People ◽  
X Ray ◽  
The Metabolic Syndrome ◽  
Increased Risk

Background:Obesity is a recognized risk factor for osteoarthritis (OA) of the knee joints, which is associated with increased biomechanical stress. However, the association of OA with metabolic syndrome is more multifaceted, since overweight and obese people have a similar increased risk of OA of the hand joints that do not carry weight, due to systemic factors.Objectives:To identify the features of the course of OA in overweight patients.Methods:52 patients with an established diagnosis of osteoarthritis were examined: women - 84.6%, men - 15.4%, average age - 60.9 ± 8.9 years (32 to 78 years). Clinical examination, calculation of body mass index (BMI), determination of the X-ray stage of OA according to the Kellgren and Lawrence system; ultrasound examination of the knee joints; assessment of the severity of pain according to visual analog scale (VAS); the index WOMAC was used to evaluate pain, stiffness and physical function. We evaluated the quality of life by EQ-5D.Results:The duration of OA was 8.75 [2.58; 26] years. The distribution of patients according to the X-ray stage of OA: I - 9.6%, II - 57.6%, III - 26.9%, IV - 5.9% of patients. The BMI range was from 21 to 43 kg/. A BMI up to 30 kg/ was found in 22 patients: 17.3% - normal weight, 25% - excess body weight. Thirty patients has BMI more than 30 kg/: I degree - 38.4%, II degree - 15.3%, III degree - 4%. Obese patients rated pain according to the VAS scale of 1.3 the score is more intensively than patients with a BMI <30 kg/m2(p <0.001). A detailed examination of each subsequent degree of obesity revealed a tendency to reduce the pain syndrome from 7.52 points at 1 degree of obesity to 5 points at 3 degrees of obesity (p <0.001). With increasing body weight, there was an increase in difficulties in daily activities according to the WOMAC (p <0.05). Reactive knee synovitis was detected in 25 (48%) patients. The incidence of synovitis in patients with a BMI <30 kg / m2is 27%, with a BMI> 30 kg / m2is 68%. Patients with obesity of 1stdegree had synovitis in 65%, 2nddegree - 75%, 3rddegree - 84% of cases (p <0.05). A high correlation between the x-ray stage of OA and BMI (r = 0.74; p <0.001) was revealed. According to the EQ-5D questionnaire, patients with the 1stdegree of obesity (2.31 ± 1.3) were very anxious, but the level of anxiety decreases in patients with 3rddegree of obesity (1.44 ± 0.9) and it’s equal to that in individuals with normal body weight (1.33 ± 0.8).Conclusion:The existence of obesity in patients with OA is associated with an increase in pain, a significant decrease in functional ability, a presence of reactive synovitis of the knee joints, aggravation of the X-ray stage of OA, and the appearance of anxiety and depression. However, with the further progression of obesity, the levels of anxiety for one’s condition decrease.References:[1]Felson DT, Zhang Y, Hannan MT et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham study. Arthritis Rheum. 1997; 40: 728–733.[2]Huffman KM. Osteoarthritis and the metabolic syndrome: more evidence that the etiology of OA is different in men and women. 2012; 20 (7): 603–604.Disclosure of Interests:None declared

Assays for Phospholipid-Dependent Formation of Thrombin and Xa: A Potential Method for Quantifying Lupus Anticoagulant Activity

1991 ◽  
Vol 66 (04) ◽  
pp. 453-458 ◽  
Author(s):  
John T Brandt
Keyword(s):  
Specific Activity ◽  
Anticoagulant Activity ◽  
Factor Xa ◽  
Clinical Importance ◽  
Potential Method ◽  
Quantitative Expression ◽  
Increased Risk ◽  
Apparent Association

SummaryLupus anticoagulants (LAs) are antibodies which interfere with phospholipid-dependent procoagulant reactions. Their clinical importance is due to their apparent association with an increased risk of thrombo-embolic disease. To date there have been few assays for quantifying the specific activity of these antibodies in vitro and this has hampered attempts to purify and characterize these antibodies. Methods for determining phospholipid-dependent generation of thrombin and factor Xa are described. Isolated IgG fractions from 7 of 9 patients with LAs were found to reproducibly inhibit enzyme generation in these assay systems, permitting quantitative expression of inhibitor activity. Different patterns of inhibitory activity, based on the relative inhibition of thrombin and factor Xa generation, were found, further substantiating the known heterogeneity of these antibodies. These systems may prove helpful in further purification and characterization of LAs.

Effects of Heparin Oligosaccharides with High Affinity for Antithrombin III in Experimental Venous Thrombosis

1982 ◽  
Vol 47 (03) ◽  
pp. 244-248 ◽  
Author(s):  
D P Thomas ◽  
Rosemary E Merton ◽  
T W Barrowcliffe ◽  
L Thunberg ◽  
U Lindahl
Keyword(s):  
Antithrombin Iii ◽  
Specific Activity ◽  
High Specific Activity ◽  
Factor Xa ◽  
Blood Levels ◽  
Thrombin Time ◽  
High Affinity ◽  
Very High

SummaryThe in vitro and in vivo characteristics of two oligosaccharide heparin fragments have been compared to those of unfractionated mucosal heparin. A decasaccharide fragment had essentially no activity by APTT or calcium thrombin time assays in vitro, but possessed very high specific activity by anti-Factor Xa assays. When injected into rabbits at doses of up to 80 ¼g/kg, this fragment was relatively ineffective in impairing stasis thrombosis despite producing high blood levels by anti-Xa assays. A 16-18 monosaccharide fragment had even higher specific activity (almost 2000 iu/mg) by chromogenic substrate anti-Xa assay, with minimal activity by APTT. When injected in vivo, this fragment gave low blood levels by APTT, very high anti-Xa levels, and was more effective in preventing thrombosis than the decasaccharide fragment. However, in comparison with unfractionated heparin, the 16-18 monosaccharide fragment was only partially effective in preventing thrombosis, despite producing much higher blood levels by anti-Xa assays.It is concluded that the high-affinity binding of a heparin fragment to antithrombin III does not by itself impair venous thrombogenesis, and that the anti-Factor Xa activity of heparin is only a partial expression of its therapeutic potential.

Hand-assisted laparoscopic nephrectomy in morbidly obese patients

2020 ◽  
Vol 99 (6) ◽  
pp. 271-276
Keyword(s):  
Body Weight ◽  
Surgical Technique ◽  
Blood Loss ◽  
Hospital Stay ◽  
Kidney Cancer ◽  
The Body ◽  
Laparoscopic Nephrectomy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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