Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma

Abstract

Sarcopenic obesity (SO), which is defined as a high ratio of visceral adipose tissue to skeletal muscle, is a well-known risk factor for post-hepatectomy outcomes in patients with hepatocellular carcinoma. However, few studies have evaluated the effect of SO on postoperative outcomes in patients with hilar cholangiocarcinoma (CCC). This retrospective study aimed to evaluate the effect of preoperative SO on postoperative outcomes in patients with hilar CCC following major hepatectomy. Preoperative SO was assessed in 328 patients undergoing hepatectomy for hilar CCC at three institutions between 2006 and 2016. SO was calculated from cross-sectional visceral fat and muscle area displayed on preoperative CT imaging. Preoperative SO was present in 98 patients (29.9%). The major complication rate in patients with SO was higher than in those without SO (54.1% vs. 37.0%, p = 0.004). Additionally, postoperative hospital stays were prolonged in patients with SO (18.5 vs. 16.5 days, p = 0.038). After multivariable analysis, SO was identified as an independent risk factor for major complications after hepatectomy in hilar CCC patients (OR = 0.866, 95% CI: 1.148–3.034, p = 0.012). Careful postoperative management is needed after major hepatectomy in hilar CCC patients with SO.

Prognostic impact of preoperative skeletal muscle change from diagnosis to surgery in patients with perihilar cholangiocarcinoma

“…Recently, besides sarcopenia, there have been reports that sarcopenic obesity is an important prognostic factor for malignancy 27 . However, when limited to PHC, while there are some reports of sarcopenic obesity being associated with postoperative complications, there are still few reports about long‐term outcomes 28 . In the present study, sarcopenic obesity was also not associated with OS and RFS in patients with resected PHC due to univariate Cox regression analysis.…”

“… 27 However, when limited to PHC, while there are some reports of sarcopenic obesity being associated with postoperative complications, there are still few reports about long‐term outcomes. 28 In the present study, sarcopenic obesity was also not associated with OS and RFS in patients with resected PHC due to univariate Cox regression analysis. Further research is needed on the prognostic impact of sarcopenic obesity in patients with PHC.…”

Proposal of definition and diagnostic criteria for sarcopenic obesity by ESPEN and EASO

“…Consequently, it was easily supposed that co-existence of sarcopenia and obesity, called sarcopenic obesity (SO), had more strong negative impact on outcomes. Actually, not a few studies have demonstrated negative clinical impact of SO on outcomes after HBP surgery using various definitions for SO ( 6 - 10 ). We reported that patients with SO, defined by low skeletal muscle mass with high visceral fat to subcutaneous fat ratio evaluated by preoperative computed tomography (CT) image, had significant worse survival than non-sarcopenia patients and patients with sarcopenia only after liver transplantation, hepatic resection, and pancreatic resection ( 6 - 9 ).…”