Preoperative Assessment of Skeletal Muscle Mass and Muscle Quality Using Computed Tomography: Incidence of Sarcopenia in Patients with Intrahepatic Cholangiocarcinoma Selected for Liver Resection.

Francesco Ardito,Maria Cristina Mele,Francesco Razionale,Brunella Barbaro,Davide Carano,Marco Cintoni,Emanuele Rinninella,Alessandro Coppola,Felice Giuliante,Gabriele Pulcini

doi:10.3390/jcm11061530

Abstract

Background: Sarcopenia is considered a predictor of poor postoperative and long-term results following liver resection for intrahepatic cholangiocarcinoma (ICC). The aim of our study was to assess the incidence of sarcopenia in patients resected for ICC and its relation to preoperative clinical factors. Methods: Patients resected for ICC in our unit, with available preoperative CT scans within one month before operation, were enrolled in the study. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were assessed for each patient. Results: Thirty patients matched all inclusion criteria. Low SMI values were documented in 15 patients (50.0%), and low SMD values were documented in 10 patients (33.3%). SMI was significantly greater in males (p < 0.001). In patients who were underweight, the incidence of low SMI was significantly higher than that of high SMI (p = 0.031). In patients who were overweight/obese, the incidence of high SMI was significantly higher than that of low SMI (p = 0.003) and the incidence of low SMD was significantly higher than that of high SMD (p = 0.038). In the univariate analysis, no preoperative factors (clinical and tumor-related factors), in particular BMI, were found to be independent predictors of low SMI. Conclusions: The incidence of sarcopenia was 50.0% in patients selected for liver resection for ICC and was not related to the preoperative clinical factors. A multidisciplinary evaluation of the nutritional status is fundamental before liver resection in patients.

Highlights

Intrahepatic cholangiocarcinoma (ICC) represents the second most common primary malignancy of the liver [1]
In 30 of these patients, preoperative computed tomography (CT) scans were performed in our center within one month before operation, and they are the object of our study
The incidence of complications in patients with low Skeletal muscle index (SMI) was higher than in patients with high SMI, but the difference did not reach a statistical significance (46.7% vs. 26.7%, p = 0.255, respectively)

Summary

Introduction

Intrahepatic cholangiocarcinoma (ICC) represents the second most common primary malignancy of the liver [1]. Only one-third of patients have access to liver resective surgery or, more recently, liver transplants, which are the only strategies with a curative intent. In these selected patients, the 5-year overall survival rates after radical surgical treatments range between 25% and 40% [3]. Sarcopenia is considered a predictor of poor postoperative and long-term results following liver resection for intrahepatic cholangiocarcinoma (ICC). The aim of our study was to assess the incidence of sarcopenia in patients resected for ICC and its relation to preoperative clinical factors. Conclusions: The incidence of sarcopenia was 50.0% in patients selected for liver resection for ICC and was not related to the preoperative clinical factors. A multidisciplinary evaluation of the nutritional status is fundamental before liver resection in patients

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Discussion

Conclusion