B. J. Kim1, J. W. Denbo1, J. Ma2, G. Passot1, M. H. Katz1, Y. S. Chun1, C. Conrad1, J. Vauthey1, T. A. Aloia1 1University Of Texas MD Anderson Cancer Center,Surgical Oncology,Houston, TX, USA 2University Of Texas MD Anderson Cancer Center,Department Of Radiology,Houston, TX, USA
Introduction:
Although recent studies suggest that sarcopenia (ratio of skeletal muscle volume to height) correlates with complications after hepatectomy, these studies are confounded by variability in tumor and procedure factors. This study focused on a large cohort of colorectal liver metastasis (CLM) patients surgically treated exclusively with open formal right hepatectomy to isolate the influence of nutritional and physical fitness factors on post-hepatectomy outcomes.
Methods:
A prospectively maintained institutional liver surgery database was queried to identify a continuous set of CLM patients treated with right hepatectomy as their first liver directed therapy. Preoperative CT imaging was used to acquire skeletal muscle area, visceral adipose area and subcutaneous adipose area using published techniques and advanced imaging software. These measures were standardized to height (m2) to define the skeletal muscle index, visceral adipose index, subcutaneous adipose index, sarcopenia and sarcopenic obesity. These indices were compared along with patient factors including preoperative chemotherapy, postoperative morbidity and mortality.
Results:
180 patients met the inclusion criteria including 108 men and 72 women with a median age of 57 years. 72.1% received pre-hepatectomy chemotherapy. The prevalence of sarcopenia and sarcopenic obesity was 35% and 17%, respectively. Cohort outcomes included severe complication rate (30%), liver failure rate (6.7%), readmission rate (6.1%), 30-day mortality rate (2.8%) and 90-day mortality rate (4.4%). Sarcopenia was associated with higher 30-day mortality (6.3% vs 0.9%, p=0.05), and sarcopenic obesity was further associated with pneumonia (9.7% vs 2.0%, p=0.07), bile leak (16.1% vs 6.0%, p=0.05) and liver failure (16.1% vs 4.7%, p=0.02). In patients over 65 years old, sarcopenic obesity was also associated with a higher 1-year all-cause mortality rate (21.4% vs 2.6%, p=0.05).
Conclusion:
After controlling for tumor factors and case magnitude by limiting the patient cohort to only right hepatectomies, sarcopenic obesity was found to significantly impact post-hepatectomy outcomes, including longer-term survivals in elderly patients. Given that most patients have ample time for intervention during preoperative systemic therapy administration, sarcopenia should be assessed at diagnosis of liver metastases and remedied with nutritional and physical prehabilitation prior to surgery.