title: Body composition and outcome in patients undergoing resection of colorectal liver metastases.
abstract: BACKGROUND
  Recent evidence suggests that depletion of skeletal muscle mass (sarcopenia) and an increased amount of intra-abdominal fat (central obesity) influence cancer statistics. This study investigated the impact of sarcopenia and central obesity on survival in patients undergoing liver resection for colorectal liver metastases (CLM).
  
  
  METHODS
  Diagnostic imaging from patients who had hepatic resection for CLM in one centre between 2001 and 2009, and who had assessable perioperative computed tomograms, was analysed retrospectively. Total cross-sectional areas of skeletal muscle and intra-abdominal fat, and their influence on outcome, were analysed.
  
  
  RESULTS
  Of the 196 patients included in the study, 38 (19·4 per cent) were classified as having sarcopenia. Five-year disease-free (15 per cent versus 28·5 per cent in patients without sarcopenia; P = 0·002) and overall (20 per cent versus 49·9 per cent respectively; P < 0·001) survival rates were lower for patients with sarcopenia at a median follow-up of 29 (range 1-97) months. Sarcopenia was an independent predictor of worse recurrence-free (hazard ratio (HR) 1·88, 95 per cent confidence interval 1·25 to 2·82; P = 0·002) and overall (HR 2·53, 1·60 to 4·01; P < 0·001) survival. Central obesity was associated with an increased risk of recurrence in men (P = 0·032), but not in women (P = 0·712).
  
  
  CONCLUSIONS
  Sarcopenia has a negative impact on cancer outcomes following resection of CLM.
authors.affiliation: Department of Surgery, Erasmus MC, Rotterdam, 'S Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: van Vledder
authors.forename: S
authors.initials: S
authors.lastname: Levolger
authors.forename: N
authors.initials: N
authors.lastname: Ayez
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
authors.forename: T C K
authors.initials: TC
authors.lastname: Tran
authors.forename: J N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001823:Body Composition / Q000502:physiology*; D015179:Colorectal Neoplasms; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D056128:Obesity, Abdominal / Q000150:complications* / Q000473:pathology; D011446:Prospective Studies; D055948:Sarcopenia / Q000150:complications* / Q000473:pathology; D016896:Treatment Outcome