Preoperative sarcopenia was identified as a strong and independent risk factor for clinically relevant POPF formation after PD. Perioperative rehabilitation and nutrition therapy may contribute to the prevention of POPF formation and a safer PD.

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Abstract.Background: Drug development in hepatocellular carcinoma (HCC) is limited by disease heterogeneity, with hepatic reserve being a major source of variation in survival outcomes. The albumin-bilirubin (ALBI) grade is a validated index of liver function in patients with HCC. Aims:We tested the accuracy of the ALBI grade in predicting post-sorafenib overall survival (PSOS) in patients who permanently discontinued treatment.Methods: From a prospectively maintained international database of 447 consecutive referrals, we derived 386 eligible patients treated with sorafenib within Barcelona Clinic Liver Cancer (BCLC) C stage (62%), 75% of whom were of Child-Turcotte-Pugh (CTP) class A at initiation. Clinical variables at sorafenib discontinuation were analyzed for their impact on PSOS using uni-and multivariable analyses.Results: Median PSOS of the 386 eligible patients was 3.4 months and median sorafenib duration was 2.9 months, with commonest causes of cessation being disease progression (68%) and toxicity (24%). At discontinuation, 92 patients (24%) progressed to terminal stage, due to worsening CTP to class C in 40 (10%). The ALBI grade predicted for PSOS in the whole patient population and in candidates for second line therapies (n=294) with median PSOS of 17.5 and 7.5 months for grades 1 and 2, independently of BCLC stage and subsequent therapies (p<0.001). Conclusions:The ALBI grade at sorafenib discontinuation identifies a subset of patients with prolonged stability of hepatic reserve and superior survival. This may allow

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