Skip to main content
SpringerLink
Log in

Preoperative Sarcopenia Negatively Impacts Postoperative Outcomes Following Major Hepatectomy with Extrahepatic Bile Duct Resection

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma remains a highly morbid procedure. The association between preoperative sarcopenia and postoperative morbidity/mortality has been reported for various types of surgeries. The objective was to analyze the relationship between preoperative sarcopenia and postoperative morbidity/mortality in patients who underwent major hepatectomy with extrahepatic bile duct resection.

Methods

This study included 256 patients who underwent major hepatectomy with extrahepatic bile duct resection from 2008 to 2014. Preoperative sarcopenia was assessed by a measurement of the total psoas muscle area (TPA). The measured TPA was normalized by height. Preoperative sarcopenia was defined as the presence of a normalized TPA in the lowest sex-specific tertile.

Results

A total of 54 males and 31 females were determined to have preoperative sarcopenia. The length of the postoperative hospital stay for patients with sarcopenia was significantly longer than for those without sarcopenia (39 vs 30 days, p < 0.001). Patients with sarcopenia experienced a significantly higher rate of liver failure (ISGLS grade ≥ B) (33 vs 16 %), major complications with Clavien grade ≥ 3 (54 vs 37 %), and intra-abdominal abscess (29 vs 18 %) than those without sarcopenia (all p < 0.05). After a multivariate analysis, low normalized TPA (male <567 mm2/m2; female <395 mm2/m2) was identified as an independent risk factor for the development of liver failure (odds ratio 2.46).

Conclusions

This study demonstrated that preoperative sarcopenia increased the morbidity rate including the rate of liver failure, in patients who underwent major hepatectomy with extrahepatic bile duct resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yokoyama Y, Ebata T, Igami T et al (2014) Predictive power of prothrombin time and serum total bilirubin for postoperative mortality after major hepatectomy with extrahepatic bile duct resection. Surgery 155:504–511

    Article  PubMed  Google Scholar 

  2. Nagino M, Ebata T, Yokoyama Y et al (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 258:129–140

    Article  PubMed  Google Scholar 

  3. Krell RW, Kaul DR, Martin AR et al (2013) Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transpl 19:1396–1402

    Article  PubMed  Google Scholar 

  4. Kaido T, Ogawa K, Fujimoto Y et al (2013) Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transpl 13:1549–1556

    Article  CAS  Google Scholar 

  5. Peng P, Hyder O, Firoozmand A et al (2012) Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg 16:1478–1486

    Article  PubMed Central  PubMed  Google Scholar 

  6. Smith AB, Deal AM, Yu H et al (2014) Sarcopenia as a predictor of complications and survival following radical cystectomy. J Urol 191(6):1714–1720

    Article  PubMed  Google Scholar 

  7. Voron T, Tselikas L, Pietrasz D et al (2014) Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma. Ann Surg. doi:10.1097/SLA.0000000000000743

  8. Harimoto N, Shirabe K, Yamashita YI et al (2013) Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg 100:1523–1530

    Article  CAS  PubMed  Google Scholar 

  9. van Vledder MG, Levolger S, Ayez N et al (2012) Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg 99:550–557

    Article  PubMed  Google Scholar 

  10. Peng PD, van Vledder MG, Tsai S et al (2011) Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford) 13:439–446

    Article  Google Scholar 

  11. Roy LB, Edwards PA, Barr LH (1985) The value of nutritional assessment in the surgical patient. JPEN J Parenter Enter Nutr 9:170–172

    Article  CAS  Google Scholar 

  12. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  13. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    Article  PubMed  Google Scholar 

  14. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  PubMed  Google Scholar 

  15. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  16. Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763

    Article  CAS  PubMed  Google Scholar 

  17. Mourtzakis M, Prado CM, Lieffers JR et al (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006

    Article  PubMed  Google Scholar 

  18. Dodson RM, Firoozmand A, Hyder O et al (2013) Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies. J Gastrointest Surg 17:2123–2132

    Article  PubMed Central  PubMed  Google Scholar 

  19. Dello SA, Lodewick TM, van Dam RM et al (2013) Sarcopenia negatively affects preoperative total functional liver volume in patients undergoing liver resection. HPB (Oxford) 15:165–169

    Article  Google Scholar 

  20. Lieffers JR, Bathe OF, Fassbender K et al (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107:931–936

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412–423

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yoshida R, Yagi T, Sadamori H et al (2012) Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation. J Hepatobiliary Pancreat Sci 19:438–448

    Article  PubMed  Google Scholar 

  23. Reynolds JV, O’Farrelly C, Feighery C et al (1996) Impaired gut barrier function in malnourished patients. Br J Surg 83:1288–1291

    Article  CAS  PubMed  Google Scholar 

  24. Lustgarten MS, Price LL, Chale A et al (2014) Branched chain amino acids are associated with muscle mass in functionally limited older adults. J Gerontol A 69:717–724

    Article  CAS  Google Scholar 

  25. Mayo NE, Feldman L, Scott S et al (2011) Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery 150:505–514

    Article  PubMed  Google Scholar 

  26. Carli F, Brown R, Kennepohl S (2012) Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer. Can J Anaesth 59:779–784

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Hidehiko Otsuji, Yukihiro Yokoyama, Tomoki Ebata, Tsuyoshi Igami, Gen Sugawara, Takashi Mizuno & Nagino Masato

Authors
  1. Hidehiko Otsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yukihiro Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomoki Ebata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tsuyoshi Igami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gen Sugawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nagino Masato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nagino Masato.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otsuji, H., Yokoyama, Y., Ebata, T. et al. Preoperative Sarcopenia Negatively Impacts Postoperative Outcomes Following Major Hepatectomy with Extrahepatic Bile Duct Resection. World J Surg 39, 1494–1500 (2015). https://doi.org/10.1007/s00268-015-2988-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-2988-6

Keywords

Search

Navigation