Lodewick Toine M, van Nijnatten Thiemo J A, van Dam Ronald M, van Mierlo Kim, Dello Simon A W G, Neumann Ulf P, Olde Damink Steven W M, Dejong Cornelis H C
Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, Division of General, Visceral and Transplantation Surgery, RWTH Aachen University, Aachen, Germany; Euregional HPB Collaboration Aachen-Maastricht, Aachen-Maastricht, Germany-The Netherlands.
HPB (Oxford). 2015 May;17(5):438-46. doi: 10.1111/hpb.12373. Epub 2014 Dec 16.
The impact of body composition on outcomes after surgery for colorectal liver metastases (CRLM) remains unclear. The aim of the present study was to determine the influence of sarcopenia, obesity and sarcopenic obesity on morbidity, disease-free (DFS) and overall survival (OS).
Between 2005 and 2012, all patients undergoing a partial liver resection for CRLM in the Maastricht University Medical Centre, and who underwent computed tomography (CT) imaging within 3 months before liver surgery, were included. Body composition was primarily based on pre-operative CT measurements. Sarcopenia was based on total muscle area at the level of the third lumbar vertebra and predefined body mass index (BMI)- and gender-specific cut-off values for sarcopenia were used. Body fat percentages were calculated and the top 40% for men and women were considered obese.
Of the 171 included patients undergoing liver surgery for CRLM, 80 (46.8%) patients were sarcopenic, 69 (40.4%) obese and 49 (28.7%) sarcopenic obese. The presence of sarcopenia, obesity or sarcopenic obesity did not affect the complication rates. However, readmission rates were significantly increased in patients with (sarcopenic) obesity (P < 0.05). Surprisingly, obesity seemed to prolong OS (P = 0.021) and was identified as an independent predictor [hazard ratio (HR):0.58 and P = 0.046] for better OS. Sarcopenia and sarcopenic obesity did not affect DFS or OS.
Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM.
身体组成对结直肠癌肝转移（CRLM）手术后结局的影响仍不明确。本研究的目的是确定肌肉减少症、肥胖症和肌肉减少性肥胖对发病率、无病生存期（DFS）和总生存期（OS）的影响。
纳入2005年至2012年间在马斯特里赫特大学医学中心接受CRLM部分肝切除术且在肝手术前3个月内接受计算机断层扫描（CT）成像的所有患者。身体组成主要基于术前CT测量。肌肉减少症基于第三腰椎水平的总肌肉面积，并使用了针对肌肉减少症的预先定义的体重指数（BMI）和性别特异性临界值。计算体脂百分比，男性和女性中前40%被视为肥胖。
在171例接受CRLM肝手术的纳入患者中，80例（46.8%）患有肌肉减少症，69例（40.4%）肥胖，49例（28.7%）肌肉减少性肥胖。肌肉减少症、肥胖症或肌肉减少性肥胖的存在不影响并发症发生率。然而，（肌肉减少性）肥胖患者的再入院率显著增加（P<0.05）。令人惊讶的是，肥胖似乎能延长总生存期（P=0.021），并被确定为总生存期更好的独立预测因素[风险比（HR）：0.58，P=0.046]。肌肉减少症和肌肉减少性肥胖不影响DFS或OS。
肌肉减少症、肥胖症和肌肉减少性肥胖不会使CRLM部分肝切除术后的DFS、OS和并发症发生率恶化。
