Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma

Okumura, Shinya; Kaido, Toshimi; Hamaguchi, Yuhei; Kobayashi, Atsushi; Shirai, Hisaya; Fujimoto, Yasuhiro; Iida, Takuya; Yagi, Shintaro; Taura, Kojiro; Hatano, Etsuro; Okajima, Hideaki; Üemoto, Shinji

doi:10.1245/s10434-016-5668-3

Cited by 108 publications

(132 citation statements)

References 39 publications

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“…Second, it is necessary to consider whether the use of the cutoff values for body composition parameters that we had previously investigated was adequate in this study. In our previous studies [23,25,26,37], the cutoff values for body composition parameters had been determined based on receiver operating characteristic curves. Although the use of receiver operating characteristic curves provides a more accurate and objective method than the use of SDs for designing cutoff levels, these values differ markedly between study populations.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Objective: Visceral adiposity, defined as a high visceral-to-subcutaneous adipose tissue area ratio (VSR), has been shown to be associated with poor outcomes in several cancers. However, in the surgical field, the significance of visceral adiposity remains controversial. The present study investigated the impact of visceral adiposity as well as sarcopenic factors (low muscularity) on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study analyzed data from 606 patients undergoing hepatectomy for HCC at our institution between April 2005 and March 2016. Using preoperative plain computed tomography imaging at the level of the third lumbar vertebra, visceral adiposity, skeletal muscle mass, and muscle quality were evaluated by the VSR, skeletal muscle mass index (SMI), and intramuscular adipose tissue content (IMAC), respectively. The impact of these parameters on outcomes after hepatectomy for HCC was analyzed. Results: The overall survival rate was significantly lower among patients with a high VSR (p < 0.001) than among patients with a normal VSR. Similarly, the recurrence-free survival rate was significantly lower among patients with a high VSR (p = 0.016). A high VSR, low SMI, and high IMAC contributed to an increased risk of death (p < 0.001) and HCC recurrence (p < 0.001) in an additive manner. Multivariate analysis showed that not only preoperative low muscularity but also visceral adiposity was a significant risk factor for mortality (hazard ratio [HR] = 1.566, p < 0.001) and HCC recurrence (HR = 1.329, p = 0.020) after hepatectomy for HCC. Conclusions: Preoperative visceral adiposity, as well as low muscularity, was closely related to poor outcomes after hepatectomy for HCC. It is crucial to establish a new strategy including perioperative nutritional interventions with rehabilitation for better outcomes after hepatectomy for HCC.

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Section: Discussionmentioning

confidence: 99%

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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“…As shown in Figure 2a, based on 18 studies [11, 13, 19, 21, 23-28, 32, 34, 36-39, 40, 42] comprising 3,501 patients and 782 major complications, low preoperative SMI was associated with an increased risk of major complications (RR 1.36; 95% CI 1.14-1.63; p = 0.0008; I 2 = 24%). MA and RA As shown in Figure 2c, based on 5 studies [13,24,37,38,41] comprising 885 patients and 221 major complications, preoperative incidence of sarcopenia, which was defined by MA/radiation attenuation on CT was associated with an increased risk of major complications (RR 1.40; 95% CI 1.14-1.73; p = 0.002; I 2 = 4%).…”

Section: Cutoff For the Sarcopenia Indexmentioning

confidence: 99%

“…Fifteen studies [11,13,[20][21][22][23] [32], and 1 in China [26]. Among the included studies, 13 studies were directed at liver [11,13,[19][20][21][22][23][24][25][26][27][28][29] malignancy, 2 bile duct [30,31], 6 pancreas [12,14,[32][33][34][35], 2 periampullary [36,37], 4 periampullary and pancreas [38][39][40][41], and 1 hepatopancreatobiliary [42]. The sample size ranged from 67 to 763.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All of the image analysis was based on CT, and the third lumbar vertebra was the most commonly used level. SMI/ TAMA was the most commonly used index, and it was used in 16 studies [11, 13, 19, 21, 23-28, 32, 34, 36-39], with SBI in 2 studies [40,42], PMI/TPA in 7 studies [12,20,22,[29][30][31]33], MA/RA in 5 studies [13,24,37,38,41], IMAC in 4 studies [20,27,31,33], HUAC in 1 study [35], LPMA in 1 study [14], and TPV in 1 study [12] ( Table 3).…”

Section: Definition Of Sarcopeniamentioning

confidence: 99%

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Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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“…In addition to LT, we recently reported the significance of preoperative low quality as well as quantity of skeletal muscle in patients who underwent surgery for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, biliary cancer, and pancreatic cancer (12)(13)(14)(15). In these cancers, low skeletal muscle mass and muscle quality are closely involved with impaired outcomes.…”

Section: To the Editormentioning

confidence: 99%

Sarcopenia plays a crucial role in liver transplantation

Kaido

Hamaguchi

Üemoto

2017

Hepatobiliary Surg. Nutr.

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Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma

Abstract: Although stage was the most important factor, low skeletal muscle mass and quality were closely related to mortality after resection of ICC in patients with stage I-III.

Cited by 108 publications

References 39 publications

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Sarcopenia plays a crucial role in liver transplantation

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