Sarcopenia affects liver regeneration and postoperative course after a major hepatectomy. A prospective study on 125 patients using HIDA scintigraphy.

Abstract

Background: The impact of sarcopenia on liver regeneration capacities remains unknown. Methods: Between 2011 and 2015, 125 patients undergoing major hepatectomy (≥3segments) had computed tomography and 99mTc-mebrofenin SPECT-scintigraphy performed preoperatively and postoperatively at day 7 and 1 month for measurements of total and remnant liver volume (RLV) and intrinsic function. Muscle mass measured at L3 vertebrae level identified sarcopenia. Impact of sarcopenia was analyzed on volume/function changes, 3-month morbi-mortality (Clavien) and liver failure rates. Results: Sarcopenic patients (SP;N=69) were significantly older than non sarcopenic (NSP), with a lower BMI and more frequent malignancies, but with comparable liver function and volume. Postoperatively, SP and NSP had similar overall and severe morbidity (>3a,23.2%vs16.4%; p=0.35), and mortality (8.7%vs3.6%;p=0.3). Nevertheless, SP showed higher rates of ISGLS PHLF (24.6%vs10.9%; p=0.05), clinically-significant PHLF (Peak_Bil>7mg/dL: 14.5%vs1.8%; p=0.02), and PHLF-related mortality (10.1%vs1.8%; p=0.075). After matching patients on the extent of resection (RLV/body weight ratio ±0.03%; 40 patients each), SP had comparable intrinsic function at D7 but a lower volumetric gain (+305cc±170cc vs.+372cc±199cc for NSP; p=0.044). These differences were less markedat 1M. Conclusion: This prospective study using first sequential SPECT-scintigraphy showed that sarcopenia is associated with a slower liver regeneration, resulting in higher PHLF-related morbi-mortality.