The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

M. Runkel,M. Benndorf,T. D. Diallo,S. Fichtner‐Feigl,S. A. Lang,F. Bamberg

doi:10.1007/s00268-021-06073-9

M. Runkel, M. Benndorf + Show 4 more

Open Access

https://doi.org/10.1007/s00268-021-06073-9

Copy DOI

Abstract

BackgroundThe impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases.MethodsNinety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3.ResultsFifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications.ConclusionVisceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

Highlights

Several aspects of body composition, in particular the amount and distribution of body fat and the amount and composition of lean muscle mass, are understood to be important health outcomes
This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases
Recognition of extremes in body compositions could prompt to perioperative interventions and improve postoperative outcomes

Summary

Introduction

Several aspects of body composition, in particular the amount and distribution of body fat and the amount and composition of lean muscle mass, are understood to be important health outcomes. World J Surg (2021) 45:2218–2226 muscle mass, strength and function is known as sarcopenia It was first described by Rosenberg et al in the aging population, where it increased all-cause mortality [4,5,6,7]. We selected the group of patients with resections of synchronous colorectal liver metastases (CRLM) because of an expected high prevalence of pathological body compositions, a high postoperative morbidity and the availability of preoperative CT scans of the abdomen. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications

Results

Discussion

Conclusion