The Impact of Sarcopenia on Overall and Disease-free Survival after Liver Resection for Colorectal Liver Metastasis

Abstract

Purpose: Current knowledge indicates that malnutrition increases the rate of post-operative complications and decreases the outcomes after major surgery. The aim of the present study was to determine the influence of sarcopenia on disease-free (DFS) and overall survival (OS). Methods: A retrospective study of patients resected for colorectal liver metastasis during the period 2016 to 2020 was conducted. The two groups were compared depending on the presence of sarcopenia (total psoas area index at the preoperative CT scan) and for overall patient and disease survival using Kaplan-Meier and Cox regression analyses. Results: A total of 28 patients were operated during the period of the study (85,7% were wedge resections, 7,4% left lateral resection, 3,6% right hepatectomy and 3,6% segmentectomy). There were no significant differences in terms of demographic, clinical, and perioperative variables between the groups, nevertheless 80% of the patients that had postoperative morbidity were sarcopenic (p=0.459). The sarcopenic patients had a median of 16.6 months vs 17.8 months of DFS for (p=0.525). The 1-year DFS for the non-sarcopenic group was 66.7% compared to 50.2% in the sarcopenic group (log Rank p=0.525). The 5-year Kaplan Meier patient survival rate was 100% for the no sarcopenic patients and 62.5% for the sarcopenic patients although this difference did not reach the statistical significance (log Rank p=0.402). In the multivariable Cox regression analysis, the sarcopenia did not result as a predictive factor. Conclusion: There is a trend for sarcopenic patients with colorectal liver metastasis to have less 1-year and DFS. A multicenter analysis with bigger number of patients will be needed to confirm this trend and in that case potentiate the preoperative nutrition assessment and management of sarcopenic patients.