Sarcopenia, Obesity, and Outcomes Following Hepatic Resection for Colorectal Liver Metastases: A Systematic Review

Abstract

Introduction: Obesity is a well described risk factor for the development of colorectal cancer. Some data suggest that obese patients with advanced colorectal cancer may have improved outcomes. Limited evidence exists in the case of obese patients undergoing hepatic resection for colorectal liver metastases. Sarcopenia has been associated with poorer outcomes for patients treated with chemotherapy, but there are limited data for these patients undergoing hepatic resection. Methods: Pubmed, Embase, Cochrane Central, Web of Science, SCOPUS, and CINAHL databases were searched to identify articles examining outcomes for patients undergoing liver resection or metastatectomy for colorectal liver metastases, with subgroup evaluation of obese, sarcopenic, or sarcopenic obese patients. Relevant articles were selected in accordance with PRISMA guidelines. Primary outcomes were overall survival and disease-free survival. Results: Thirteen studies met the inclusion criteria incorporating 2,936 patients. Three studies examined outcomes for obese patients alone, eight included sarcopenic patients alone, and two examined outcomes for both groups. One study included a subgroup for sarcopenic obese patients (n=49). Significant methodological heterogeneity was noted between studies in the definition of both sarcopenia and obesity. One study was of high quality, the remaining twelve were of adequate quality. 5-year overall survival was 0-60%, 11-59%, and 11-89% for obese, sarcopenic, and the control groups respectively. Conclusion: Limited and heterogenous evidence exists describing the impact of obesity and sarcopenia on outcomes following hepatic resection for colorectal liver metastases. Obese patients do not appear to have worse oncological outcomes, whereas sarcopenia is a predictor of poorer long-term survival.