Abstract
BackgroundSurgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative intervention targeting identified risk factors could improve postoperative outcome. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM).MethodsData of patients diagnosed with CRLM who underwent liver resection between 2006 and 2016 were analysed. Muscle quantity (psoas muscle index [PMI]), and muscle quality, (average muscle radiation attenuation [AMA] of the psoas), were measured using computed tomography. Changes in PMI and AMA of psoas after surgery were assessed.ResultsA total of 128 patients were analysed; 67 (52%) had surgery-related loss of muscle quantity and 83 (65%) muscle quality loss. Chronic obstructive pulmonary disease (COPD) (P = 0.045) and diabetes (P = 0.003) were risk factors for surgery-related loss of muscle quantity. A higher age (P = 0.002), open resection (P = 0.003) and longer operation time (P = 0.033) were associated with muscle quality loss. Overall survival was lower in patients with both muscle quantity and quality loss compared to other categories (P = 0.049). The rate of postoperative complications was significantly higher in the group with surgery-related loss of muscle quality.ConclusionsRisk factors for surgery-related muscle loss were identified. Overall survival was lowest in patients with both muscle quantity and quality loss. Complication rate was higher in patients with surgery-related loss of muscle quality.
Highlights
Resection with curative intent is the treatment of choice for colorectal liver metastasis (CLRM) [1, 2]
The impact of preoperative body composition variables has been well described in literature, less studies have investigated the process of surgery-related changes in muscle quantity and quality
Preoperative computed tomography (CT) scans were performed with a mean time before operation of 28.2 ± 9.6 days, whereas postsurgical CT scans were performed after a mean of 7.1 ± 3 days
Summary
Resection with curative intent is the treatment of choice for colorectal liver metastasis (CLRM) [1, 2]. Despite advances in surgical techniques and perioperative care, the impact of preoperative body composition variables has been well described in literature, less studies have investigated the process of surgery-related changes in muscle quantity and quality. The negative impact of this so-called surgery-related muscle loss (SML) on long-term survival after pancreatic surgery was recently demonstrated [17]. There is minimal literature describing surgery-related changes in muscle quality [18]. Surgery-related loss of muscle quantity negatively affects postoperative outcomes. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM)
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