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.
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.
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).
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 to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
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
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
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
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
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
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
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
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
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
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
Roy LB, Edwards PA, Barr LH (1985) The value of nutritional assessment in the surgical patient. JPEN J Parenter Enter Nutr 9:170–172
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
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
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
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763
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
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
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
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
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
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
Reynolds JV, O’Farrelly C, Feighery C et al (1996) Impaired gut barrier function in malnourished patients. Br J Surg 83:1288–1291
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
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
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
Conflict of interest
About this article
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
- Major Hepatectomy
- Percutaneous Transhepatic Biliary Drainage
- Prognostic Nutritional Index
- Postoperative Liver Failure
- Clavien Grade