Effect of sarcopenia on postoperative ICU admission and length of stay after hepatic resection for Klatskin tumor

Abstract

BackgroundHepatic resection of Klatskin tumors usually requires postoperative intensive care unit (ICU) admission because of its high morbidity and mortality. Identifying surgical patients who will benefit most from ICU admission is important because of scarce resources but remains difficult. Sarcopenia is characterised by the loss of skeletal muscle mass and is associated with poor surgical outcomes.MethodsWe retrospectively analysed th.e relationship between preoperative sarcopenia and postoperative ICU admission and length of ICU stay (LOS-I) in patients who underwent hepatic resection for Klatskin tumors. Using preoperative computed tomography scans, the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra was measured and normalised to the patient’s height. Using these values, the optimal cut-off for diagnosing sarcopenia was determined using receiver operating characteristic curve analysis for each sex.ResultsOf 330 patients, 150 (45.5%) were diagnosed with sarcopenia. Patients with preoperative sarcopenia presented significantly more frequently to the ICU (77.3% vs. 47.9%, p < 0.001) and had longer total LOS-I (2.45 vs 0.89 days, p < 0.001). Moreover, patients with sarcopenia showed a significantly higher postoperative length of hospital stay, severe complication rate, and in-hospital mortality.ConclusionsSarcopenia correlated with poor postoperative outcomes, especially with the increased requirement of postoperative ICU admission and prolonged LOS-I after hepatic resection in patients with Klatskin tumors.

Body composition is associated with postoperative complications in perihilar cholangiocarcinoma

“…Patients with pCCA are particularly susceptible to obstructive jaundice, which can also contribute to inadequate intake and reduced physical activity, thereby inducing sarcopenia 28 . Sarcopenia has been identified as a significant risk factor for poor perioperative outcomes undergoing hepatectomy within 90 days in previous studies, further supporting our findings as we have observed a strong association between sarcopenia and severe postoperative complications 29 . Interestingly, previous studies have also shown that sarcopenia does not appear to be associated with postoperative complications in patients with pCCA, likely due to the limited sample size of the previous studies 7,10 …”

“…28 Sarcopenia has been identified as a significant risk factor for poor perioperative outcomes undergoing hepatectomy within 90 days in previous studies, further supporting our findings as we have observed a strong association between sarcopenia and severe postoperative complications. 29 Interestingly, previous studies have also shown that sarcopenia does not appear to be associated with postoperative complications in patients with pCCA, likely due to the limited sample size of the previous studies. 7,10 Myosteatosis is a pathological condition characterized by the accumulation of fat within muscle tissue, leading to impaired muscle and mitochondrial function.…”

“…Furthermore, sarcopenia was found to have a negative impact on OS, but no significant correlation with RFS was observed, consistent with earlier research. 29 Both sarcopenia and myosteatosis represent a loss of muscle function and quality. Inflammatory responses and oxidative stress are primary etiological factors in muscle wasting.…”

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study

“…The relatively low disease severity in our study population could explain this discrepancy with previous studies. While 61.8% of the patients were admitted to the ICU immediately after hepatic resection in a previous study [ 33 ], none were admitted to the ICU immediately after PPPD in our study.…”

“…In previous meta-analyses evaluating gastrointestinal cancer surgeries [ 31 ] and urologic cancer surgeries [ 32 ], preoperative sarcopenia increased the risk of major complications and was an independent prognostic factor for short survival and increased mortality after surgery. In a previous study evaluating hepatic resection for Klatskin tumors conducted at our institution [ 33 ], preoperative sarcopenia was associated with postoperative ICU admission, length of ICU stay, postoperative complication rate, and in-hospital mortality. In contrast, we found no association between preoperative sarcopenia and postoperative complications or mortality.…”