Preoperative computed tomography assessment of skeletal muscle mass is valuable in predicting outcomes following hepatectomy for perihilar cholangiocarcinoma.
BACKGROUND
Liver surgery for perihilar cholangiocarcinoma (PHC) is associated with high rates of morbidity and mortality.


OBJECTIVE
This study investigated the impact of low skeletal muscle mass on short- and longterm outcomes following hepatectomy for PHC.


METHODS
Patients included underwent liver surgery for PHC between 1998 and 2013. Total skeletal muscle mass was measured at the level of the third lumbar vertebra using available preoperative computed tomography images. Sex-specific cut-offs for low skeletal muscle mass were determined by optimal stratification.


RESULTS
In 100 patients, low skeletal muscle mass was present in 42 (42.0%) subjects. The rate of postoperative complications (Clavien-Dindo Grade III and higher) was greater in patients with low skeletal muscle mass (66.7% versus 48.3%; multivariable adjusted P = 0.070). Incidences of sepsis (28.6% versus 5.2%) and liver failure (35.7% versus 15.5%) were increased in patients with low skeletal muscle mass. In addition, 90-day mortality was associated with low skeletal muscle mass in univariate analysis (28.6% versus 8.6%; P = 0.009). Median overall survival was shorter in patients with low muscle mass (22.8 months versus 47.5 months; P = 0.014). On multivariable analysis, low skeletal muscle mass remained a significant prognostic factor (hazard ratio 2.02; P = 0.020).


CONCLUSIONS
Low skeletal muscle mass has a negative impact on postoperative mortality and overall survival following resection of PHC and should therefore be considered in preoperative risk assessment.
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Robert J S
RJ
Coelen
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Jimme K
JK
Wiggers
Department of Radiology, Academic Medical Centre, Amsterdam, the Netherlands.
Chung Y
CY
Nio
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Marc G
MG
Besselink
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Olivier R C
OR
Busch
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Dirk J
DJ
Gouma
Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Thomas M
TM
van Gulik
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome