The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

Abstract

Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

Body composition predictors of mortality in patients undergoing surgery for long bone metastases

“…Sarcopenia, or the involuntary loss of skeletal muscle, has been associated with risk for mortality in patients with various primary malignant neoplasms such as pancreatic, gastric, breast, and lung cancer, in addition to patients suffering from metastatic disease. [36][37][38] The underlying mechanism that links sarcopenia to mortality in patients with malignant disease has not been well defined. Various candidate mechanisms for muscle wasting have been described-ranging from muscle catabolism due to systemic inflammation, to the inhibition of myoblast differentiation caused by an uninhibited release of the negative muscle cell differentiation regulator, myostatin.…”

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

“…Both experimental and clinical analyses have demonstrated an impaired response to treatment and an impaired overall survival in patients with a reduced muscle mass and/or an impaired muscle quality [ 17 ]. Nevertheless, many questions including the magnitude of the associations and whether parameters that have been established in patients receiving surgery can be translated to patients in palliative disease stages have remained unanswered [ 18 ]. Here, we demonstrate that routine CT scans can be used to easily assess sarcopenia as well as myosteatosis in patients receiving palliative therapy for advanced-stage CCA and that both parameters represent prognostic markers for OS.…”

Insulin and cancer: a tangled web

“…Few mechanisms have been explored in humans that interrogate how visceral adiposity modulates tumor biology [ 51 , 53 , 54 ]. As alluded to earlier in this review, obesity appears to be protective for survival in lung cancer.…”

“…Sarcopenic skeletal muscles are known to be insulin resistant even in the setting of low whole-body fat stores [ 70 ], and considering that skeletal muscle is a primary site of both insulin action and glucose uptake/storage [ 71–75 ], sarcopenia contributes significantly to systemic metabolic syndrome [ 76 ]. Numerous studies have shown detrimental epidemiological consequences of sarcopenic obesity on cancer incidence, progression, and survival, with the largest influence on cancer incidence [ 53 , 54 , 69 , 77–81 ]. Likely mechanisms of sarcopenia-associated insulin resistance include reduced mitochondrial function (i.e.…”