Martin David, Maeder Yaël, Kobayashi Kosuke, Schneider Michael, Koerfer Joachim, Melloul Emmanuel, Halkic Nermin, Hübner Martin, Demartines Nicolas, Becce Fabio, Uldry Emilie
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland.
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland.
Cancers (Basel). 2022 Jan 5;14(1):261. doi: 10.3390/cancers14010261.
This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m) than patients without sarcopenia (59.3 years, < 0.01, and 27.7 kg/m, < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.
这项回顾性观察性研究旨在评估通过CT成像评估的术前肌肉减少症是否与接受肝切除患者的术后临床结局和总生存期相关。纳入了2014年1月至2020年2月期间接受手术的患者。在术前CT扫描上于第三腰椎水平测量骨骼肌指数（SMI）。根据预先确定的SMI临界值定义术前肌肉减少症。结局指标为术后发病率、住院时间（LOS）和总生存期。在355例患者中，212例（59.7%）有术前肌肉减少症。与无肌肉减少症的患者（分别为59.3岁、<0.01和27.7kg/m²、<0.01）相比，有肌肉减少症的患者年龄显著更大（63.5岁）且BMI显著更低（23.9kg/m²）。两组间住院时间无差异（8天对8天，P=0.75），且两组主要并发症发生率相当（11.2%对11.3%，P=1.00）。有肌肉减少症的患者与无肌肉减少症的患者的中位总生存期相当（15个月对16个月，P=0.87）。仅基于CT评估，术前肌肉减少症似乎对接受肝切除患者的术后临床结局或总生存期无影响。未来的研究除了成像外，还应在术前风险分层中考虑肌肉力量和身体性能。
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