World Journal of Surgery

, Volume 40, Issue 8, pp 1959–1968 | Cite as

Muscle Steatosis is an Independent Predictor of Postoperative Complications in Patients with Hepatocellular Carcinoma

  • Yuhei Hamaguchi
  • Toshimi KaidoEmail author
  • Shinya Okumura
  • Atsushi Kobayashi
  • Yasuhiro Fujimoto
  • Kohei Ogawa
  • Akira Mori
  • Ahmed Hammad
  • Etsuro Hatano
  • Shinji Uemoto
Original Scientific Report



Skeletal muscle depletion, referred to as sarcopenia, has been shown to be an independent predictor of lower disease-free and overall survivals in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia, but its impact on surgical complications is still unknown.


A retrospective analysis of 492 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) in our institution between April 2005 and December 2014 was performed. The quality of skeletal muscle was evaluated by intramuscular adipose tissue content (IMAC) using preoperative CT imaging at the umbilical level. The impact of sarcopenia on postoperative complications and the predictors of surgical complications after hepatectomy for HCC were analyzed.


Patients with high IMAC were older and had higher body mass index, higher indocyanine green retention test at 15 min, and more operative blood loss. Among 492 patients, 108 (22 %) patients had major postoperative complications (Clavien grade ≥ III), and infectious complications were found in 74 (15 %) patients. Twelve (2 %) patients died from postoperative complications. On multivariate analysis, preoperative high IMAC was an independent risk factor for increased major postoperative complications [odds ratio (OR) 1.580; P = 0.049] and infectious complications (OR 1.903; P = 0.021).


Preoperative muscle steatosis evaluated with IMAC was closely correlated with increased postoperative complications, especially infectious complications. The preoperative nutritional intervention and rehabilitation might lead to the improvement of postoperative outcomes after hepatectomy for HCC.


Postoperative Complication Infectious Complication Operative Blood Loss Major Postoperative Complication Clavien Grade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Financial support

No financial support was received from any source for this study.

Compliance with ethical standards

Conflict of interest

All authors of this manuscript have no conflicts of interest.


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Yuhei Hamaguchi
    • 1
  • Toshimi Kaido
    • 1
    Email author
  • Shinya Okumura
    • 1
  • Atsushi Kobayashi
    • 1
  • Yasuhiro Fujimoto
    • 1
  • Kohei Ogawa
    • 1
  • Akira Mori
    • 1
  • Ahmed Hammad
    • 1
    • 2
  • Etsuro Hatano
    • 1
  • Shinji Uemoto
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Department of SurgeryMansoura UniversityMansouraEgypt

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