Yao Siyuan, Kamo Naoko, Taura Kojiro, Miyachi Yosuke, Iwamura Sena, Hirata Masaaki, Kaido Toshimi, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Gastroenterological and General Surgery, St. Luke's International Hospital, Tokyo, Japan.
Ann Surg Oncol. 2022 Jan;29(1):301-312. doi: 10.1245/s10434-021-10525-w. Epub 2021 Jul 31.
Portal vein embolization (PVE) is a common procedure for preventing hepatic insufficiency after major hepatectomy. While evaluating the body composition of surgical patients is common, the impact of muscularity defined by both muscle quantity and quality on liver hypertrophy after PVE and associated outcomes after major hepatectomy in patients with hepatobiliary cancer remain unclear.
This retrospective review included 126 patients who had undergone hepatobiliary cancer resection after PVE. Muscularity was measured on preoperative computed tomography images by combining the skeletal mass index and intramuscular adipose content. Various factors including the degree of hypertrophy (DH) of the future liver remnant and post-hepatectomy outcomes were compared according to muscularity.
DH did not differ by malignancy type. Patients with high muscularity had better DH after PVE (P = 0.028), and low muscularity was an independent predictor for poor liver hypertrophy after PVE [odds ratio (OR), 3.418; 95% confidence interval (CI), 1.129-10.352; P = 0.030]. In subgroup analyses in which patients were stratified into groups based on primary hepatobiliary tumors and metastases, low muscularity was associated with higher incidence of post-hepatectomy liver failure (PHLF) ≥ grade B (P = 0.018) and was identified as an independent predictor for high-grade PHLF (OR 3.931; 95% CI 1.113-13.885; P = 0.034) among the primary tumor group. In contrast, muscularity did not affect surgical outcomes in patients with metastases.
Low muscularity leads to poor liver hypertrophy after PVE and is also a predictor of PHLF, particularly in primary hepatobiliary cancer.
门静脉栓塞术（PVE）是预防大肝切除术后肝功能不全的常用手术。虽然评估手术患者的身体成分很常见，但肌肉量和质量所定义的肌肉状况对PVE后肝肥大以及肝胆癌患者大肝切除术后相关结局的影响仍不清楚。
这项回顾性研究纳入了126例接受PVE后行肝胆癌切除术的患者。通过结合骨骼质量指数和肌内脂肪含量，在术前计算机断层扫描图像上测量肌肉状况。根据肌肉状况比较包括未来肝残余体积肥大程度（DH）和肝切除术后结局在内的各种因素。
DH在恶性肿瘤类型之间没有差异。肌肉状况良好的患者在PVE后有更好的DH（P = 0.028），而肌肉状况差是PVE后肝肥大不良的独立预测因素[比值比（OR），3.418；95%置信区间（CI），1.129 - 10.352；P = 0.030]。在根据原发性肝胆肿瘤和转移情况将患者分层的亚组分析中，肌肉状况差与肝切除术后肝功能衰竭（PHLF）≥B级的较高发生率相关（P = 0.018），并且在原发性肿瘤组中被确定为高级别PHLF的独立预测因素（OR 3.931；95% CI 1.113 - 13.885；P = 0.034）。相比之下，肌肉状况对转移患者的手术结局没有影响。
肌肉状况差会导致PVE后肝肥大不良，也是PHLF的预测因素，尤其是在原发性肝胆癌中。
