Impact of body composition on survival and morbidity after liver resection in hepatocellular carcinoma patients
Andreas Kroh a , ∗, Diane Uschner b , Toine Lodewick c , d , e , Roman M Eickhoff a , Wenzel Schoning a , Florian T Ulmer a , c , Ulf P Neumann a , c , Marcel Binnebosel a , c
a Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
b Institute of Medical Statistics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
c Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
d Department of Radiology, Zuyderland Medical Centre, Heerlen, the Netherlands
e Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
Abstract：Background: Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk strati- fication. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepa- tocellular carcinoma.
Methods: A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level (L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated.
Results: Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic ( P = 0.035) and sarcopenic obese ( P = 0.048) patients as well as a trend favoring obese ( P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival.
Conclusions: Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients.
2019, Vol. 18 
