title: Muscle Steatosis is an Independent Predictor of Postoperative Complications in Patients with Hepatocellular Carcinoma.
abstract: Skeletal muscle depletion, referred to as sarcopenia, has been shown to be an independent predictor of lower disease-free and overall survivals in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia, but its impact on surgical complications is still unknown.
  
  
  
  A retrospective analysis of 492 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) in our institution between April 2005 and December 2014 was performed. The quality of skeletal muscle was evaluated by intramuscular adipose tissue content (IMAC) using preoperative CT imaging at the umbilical level. The impact of sarcopenia on postoperative complications and the predictors of surgical complications after hepatectomy for HCC were analyzed.
  
  
  
  Patients with high IMAC were older and had higher body mass index, higher indocyanine green retention test at 15 min, and more operative blood loss. Among 492 patients, 108 (22 %) patients had major postoperative complications (Clavien grade ≥ III), and infectious complications were found in 74 (15 %) patients. Twelve (2 %) patients died from postoperative complications. On multivariate analysis, preoperative high IMAC was an independent risk factor for increased major postoperative complications [odds ratio (OR) 1.580; P = 0.049] and infectious complications (OR 1.903; P = 0.021).
  
  
  
  Preoperative muscle steatosis evaluated with IMAC was closely correlated with increased postoperative complications, especially infectious complications. The preoperative nutritional intervention and rehabilitation might lead to the improvement of postoperative outcomes after hepatectomy for HCC.
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Hamaguchi
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan. kaido@kuhp.kyoto-u.ac.jp.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Okumura
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Mori
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.|Department of Surgery, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hammad
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Kyoto, Sakyo-ku, 606-8507, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed