Importance: Previous retrospective studies have shown that sarcopenia substantially alters the postoperative and oncological outcomes after liver resection for malignant tumors. However, the evidence is limited to small retrospective studies with heterogeneous results and the lack of standardized measurements of sarcopenia. Objective: To investigate the role of sarcopenia as a risk factor associated with 90-day morbidity after liver resection for malignant tumors. Design, Setting, and Participants: This cohort study included 234 consecutive patients undergoing liver resection for malignant tumors at San Camillo Forlanini Hospital, Rome, Italy, between June 1, 2018, and December 15, 2019. Muscle mass and strength were assessed using the skeletal muscle index (SMI) on preoperative computed tomographic scans and the handgrip strength test, respectively. Patients were then divided into the following 4 groups: group A (normal muscle mass and strength), group B (reduced muscle strength), group C (reduced muscle mass), and group D (reduced muscle mass and strength). Main Outcomes and Measures: The primary outcome of the study was 90-day morbidity. The following secondary outcomes were investigated: 90-day mortality, hospital stay, and readmission rate. Results: Sixty-four major and 170 minor hepatectomies were performed in 234 patients (median age, 66.50 [interquartile range, 58.00-74.25] years; 158 men [67.5%]). The median SMI of the entire population was 46.22 (interquartile range, 38.60-58.20) cm/m2. The median handgrip strength was 30.80 (interquartile range, 22.30-36.90) kg. Patients in group D had a statistically significantly higher rate of 90-day morbidity than patients in the other groups (51.5% [35 of 68] vs 38.7% [29 of 75] in group C, 23.1% [3 of 13] in group B, and 6.4% [5 of 78] in group A; P < .001). Compared with patients in the other groups, those in group D had a longer hospital stay (10 days vs 8 days in group C, 9 days in group B, and 6 days in group A; P < .001), and more patients in this group were readmitted to the hospital (8.8% [6 of 68] vs 5.3% [4 of 75] in group C, 7.7% [1 of 13] in group B, and 0% [0 of 78] in group A; P = .02). Sarcopenia, portal hypertension, liver cirrhosis, and biliary reconstruction were independent risk factors associated with 90-day morbidity. Conclusions and Relevance: Sarcopenia appears to be associated with adverse outcomes after liver resection for malignant tumors. Both muscle mass measurements on computed tomographic scans and muscle strength assessments with the handgrip strength test should be performed at the first clinical encounter to better classify patients and to minimize the risk of morbidity.
Importance: Previous retrospective studies have shown that sarcopenia substantially alters the postoperative and oncological outcomes after liver resection for malignant tumors. However, the evidence is limited to small retrospective studies with heterogeneous results and the lack of standardized measurements of sarcopenia. Objective: To investigate the role of sarcopenia as a risk factor associated with 90-day morbidity after liver resection for malignant tumors. Design, Setting, and Participants: This cohort study included 234 consecutive patients undergoing liver resection for malignant tumors at San Camillo Forlanini Hospital, Rome, Italy, between June 1, 2018, and December 15, 2019. Muscle mass and strength were assessed using the skeletal muscle index (SMI) on preoperative computed tomographic scans and the handgrip strength test, respectively. Patients were then divided into the following 4 groups: group A (normal muscle mass and strength), group B (reduced muscle strength), group C (reduced muscle mass), and group D (reduced muscle mass and strength). Main Outcomes and Measures: The primary outcome of the study was 90-day morbidity. The following secondary outcomes were investigated: 90-day mortality, hospital stay, and readmission rate. Results: Sixty-four major and 170 minor hepatectomies were performed in 234 patients (median age, 66.50 [interquartile range, 58.00-74.25] years; 158 men [67.5%]). The median SMI of the entire population was 46.22 (interquartile range, 38.60-58.20) cm/m2. The median handgrip strength was 30.80 (interquartile range, 22.30-36.90) kg. Patients in group D had a statistically significantly higher rate of 90-day morbidity than patients in the other groups (51.5% [35 of 68] vs 38.7% [29 of 75] in group C, 23.1% [3 of 13] in group B, and 6.4% [5 of 78] in group A; P < .001). Compared with patients in the other groups, those in group D had a longer hospital stay (10 days vs 8 days in group C, 9 days in group B, and 6 days in group A; P < .001), and more patients in this group were readmitted to the hospital (8.8% [6 of 68] vs 5.3% [4 of 75] in group C, 7.7% [1 of 13] in group B, and 0% [0 of 78] in group A; P = .02). Sarcopenia, portal hypertension, liver cirrhosis, and biliary reconstruction were independent risk factors associated with 90-day morbidity. Conclusions and Relevance: Sarcopenia appears to be associated with adverse outcomes after liver resection for malignant tumors. Both muscle mass measurements on computed tomographic scans and muscle strength assessments with the handgrip strength test should be performed at the first clinical encounter to better classify patients and to minimize the risk of morbidity.
Authors: John E Morley; Josep M Argiles; William J Evans; Shalender Bhasin; David Cella; Nicolaas E P Deutz; Wolfram Doehner; Ken C H Fearon; Luigi Ferrucci; Marc K Hellerstein; Kamyar Kalantar-Zadeh; Herbert Lochs; Neil MacDonald; Kathleen Mulligan; Maurizio Muscaritoli; Piotr Ponikowski; Mary Ellen Posthauer; Filippo Rossi Fanelli; Morrie Schambelan; Annemie M W J Schols; Michael W Schuster; Stefan D Anker Journal: J Am Med Dir Assoc Date: 2010-07 Impact factor: 4.669
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Authors: Maximilian Thormann; Jazan Omari; Maciej Pech; Robert Damm; Roland Croner; Aristotelis Perrakis; Alexandra Strobel; Andreas Wienke; Alexey Surov Journal: Langenbecks Arch Surg Date: 2022-05-18 Impact factor: 2.895
Authors: Johannes Chang; Pauline Höfer; Nina Böhling; Philipp Lingohr; Steffen Manekeller; Jörg C Kalff; Jonas Dohmen; Dominik J Kaczmarek; Christian Jansen; Carsten Meyer; Christian P Strassburg; Jonel Trebicka; Michael Praktiknjo Journal: JHEP Rep Date: 2022-01-21
Authors: Giammauro Berardi; Marco Colasanti; Roberto Luca Meniconi; Stefano Ferretti; Nicola Guglielmo; Germano Mariano; Mirco Burocchi; Alessandra Campanelli; Andrea Scotti; Alessandra Pecoraro; Marco Angrisani; Paolo Ferrari; Andrea Minervini; Camilla Gasparoli; Go Wakabayashi; Giuseppe Maria Ettorre Journal: Diagnostics (Basel) Date: 2021-11-23