Sarcopenia Increases Morbidity Risk in Liver Resection for Malignant Tumors

Sarcopenia was an independent risk factor for 90-day morbidity among patients undergoing liver resection for malignant tumors, a study cautioned.

“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,” the researchers explained.

To garner a better understanding of this possible correlation, they assessed 234 consecutive patients undergoing liver resection for malignant tumors in Italy. Patients were treated between June 1, 2018, and Dec. 15, 2019. The skeletal muscle index (SMI) was used on preoperative CT scans to determine muscle mass, and strength was determined using the handgrip strength test. Four patient groups were created: normal muscle mass and strength (group A; n=78), reduced muscle strength (group B; n=13), reduced muscle mass (group C; n=75), and reduced muscle mass and strength (group D; n=68). Ninety-day morbidity was the main outcome; 90-day mortality, hospital stay, and readmission rate were assessed as secondary outcomes.

The study population consisted of 234 patients with a median (interquartile range [IQR]) age of 66.5 (58.00–74.25) years. About two-thirds of patients (n=158; 67.5%) were male. There were 64 major and 170 minor hepatectomies.

Overall, the median (IQR) SMI was 46.22 (38.6–58.2) cm/m2, and handgrip strength was 30.8 (22.3–36.9) kg. The 90-day morbidity rate was significantly higher in group D (51.5%) compared to group A (6.4%), group B (23.1%), and group C (38.7%) (P<0.001). Hospital stay was longest in group D (10 days), followed by group B (9 days), group C (8 days), and group A (6 days) (P<0.001). Group D also had the highest rate of readmissions (8.8%), followed by group B (7.7%), group C (5.3%), and group A (0%) (P=0.02). Independent risk factors for 90-day morbidity were sarcopenia, portal hypertension, liver cirrhosis, and biliary reconstruction.

The study was published in JAMA Surgery.

In their conclusion the study authors recommended, “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.”