Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis

Abstract

The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH.

Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy

“…Patients with low SMI are more likely to develop PHLF than those with high SMI. The reason for this may be that SMI reflects the nutritional status of the patient and is an indirect marker of the patient’s frailty, defined as a condition that can reflect a reduction in the patient’s physiological reserves and therefore may affect the outcome after surgery ( 21 , 22 ). ASA scores are now commonly used to assess a patient’s holistic composite fitness before anesthesia, and we found that patients with high ASA grades had a higher risk, which is consistent with previous studies ( 23 ).…”

Effect of Sarcopenia on Survival and Health-Related Quality of Life in Patients with Hepatocellular Carcinoma after Hepatectomy

“…Although the complication rate was not statistically significant in this study, we could find a trend towards higher rates of complications, including minor and major complications, in patients with sarcopenia. In addition, Giovanni Marasco et al reported similar results that sarcopenia was associated with higher major complications (Clavien-Dindo grades III or IV) after resection of primary hepatocellular carcinoma in patients with compensated advanced chronic liver disease and portal hypertension [ 33 ].…”

Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives

“…In fact, it is associated with a series of negative prognostic elements such as a higher rate of infection, longer hospitalization, hepatic encephalopathy, poor quality of life, and increased healthcare cost. Furthermore, sarcopenia is also associated with poor survival in patients with hepatocellular carcinoma (HCC) [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. While in these kinds of patients, many data demonstrate the prognostic burden and significance of sarcopenia, there are only a few data on its pathogenic mechanism [ 72 ].…”