#VisualAbstract: Sarcopenia associated with reduced muscle mass and strength following liver resection for malignant neoplasms

1. Sarcopenia was an independent risk factor for reduced muscle mass and strength following liver resection for malignant neoplasms.

Evidence Rating Level: 2 (Good)

Sarcopenia is an involuntary, age-related loss of skeletal muscle mass and strength. This condition is known to drastically impact postoperative and oncological outcomes following liver resection for malignant neoplasms, yet evidence is limited to retrospective studies. This cohort study investigated the relationship between sarcopenia and 90-day morbidity after liver resection in this population.  A total of 234 patients undergoing liver resection for malignant neoplasms at one hospital in Rome, Italy between June 1, 2018 and December 15, 2019 were included in this study (median age [interquartile range, IQR] = 66.50 [58.00 to 74.25] years, 32.5% female). Variables of interest were skeletal muscle index (SMI) on preoperative computed tomography (CT) scans and grip strength. These patients were divided into Group A (normal muscle mass+strength), Group B (reduced muscle strength), Group C (reduced muscle mass), and Group D (reduced muscle mass+strength). One-hundred seventy minor and 64 major hepatectomies were performed among the patients. Group D comprised a subset of patients who had significantly higher rate of 90-day morbidity than patients in Group A (difference 45.1%, p<0.001), Group B (difference 28.4%, p<0.001), and Group C (difference 12.8%, p<0.001). Group D also exhibited longer hospital stays (p<0.001) and more readmissions (p = 0.02) than all other groups. Several independent risk factors were associated with 90-day morbidity: sarcopenia, portal hypertension, liver cirrhosis, biliary reconstruction. Overall, this study demonstrated that sarcopenia is associated with negative outcomes following liver resection for malignant neoplasms. Muscle mass via CT scans and muscle strength via grip test can adequately evaluate these outcomes.

Click to read the study in JAMA Surgery

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