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Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis

SIMPLE SUMMARY: Sarcopenia, which is defined as a loss of skeletal muscle mass, function and strength, is the result of major metabolic changes often observed in advanced liver disease. Its evaluation mirrors the nutritional and functional status of the patients, and thus has been recently implicate...

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Autores principales: Marasco, Giovanni, Dajti, Elton, Serenari, Matteo, Alemanni, Luigina Vanessa, Ravaioli, Federico, Ravaioli, Matteo, Vestito, Amanda, Vara, Giulio, Festi, Davide, Golfieri, Rita, Cescon, Matteo, Renzulli, Matteo, Colecchia, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025609/
https://www.ncbi.nlm.nih.gov/pubmed/35454842
http://dx.doi.org/10.3390/cancers14081935
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author Marasco, Giovanni
Dajti, Elton
Serenari, Matteo
Alemanni, Luigina Vanessa
Ravaioli, Federico
Ravaioli, Matteo
Vestito, Amanda
Vara, Giulio
Festi, Davide
Golfieri, Rita
Cescon, Matteo
Renzulli, Matteo
Colecchia, Antonio
author_facet Marasco, Giovanni
Dajti, Elton
Serenari, Matteo
Alemanni, Luigina Vanessa
Ravaioli, Federico
Ravaioli, Matteo
Vestito, Amanda
Vara, Giulio
Festi, Davide
Golfieri, Rita
Cescon, Matteo
Renzulli, Matteo
Colecchia, Antonio
author_sort Marasco, Giovanni
collection PubMed
description SIMPLE SUMMARY: Sarcopenia, which is defined as a loss of skeletal muscle mass, function and strength, is the result of major metabolic changes often observed in advanced liver disease. Its evaluation mirrors the nutritional and functional status of the patients, and thus has been recently implicated as an outcome predictor of patients with liver diseases and hepatocellular carcinoma. This study provides evidence that sarcopenia, as assessed by the skeletal muscle index, is associated with age and body mass index in liver surgery candidates. More importantly, it is associated with higher rates of major complications (Clavien-Dindo grade III or IV) in patients with compensated advanced chronic liver disease and/or portal hypertension undergoing liver resection for primary hepatocellular carcinoma. ABSTRACT: The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH.
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spelling pubmed-90256092022-04-23 Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis Marasco, Giovanni Dajti, Elton Serenari, Matteo Alemanni, Luigina Vanessa Ravaioli, Federico Ravaioli, Matteo Vestito, Amanda Vara, Giulio Festi, Davide Golfieri, Rita Cescon, Matteo Renzulli, Matteo Colecchia, Antonio Cancers (Basel) Article SIMPLE SUMMARY: Sarcopenia, which is defined as a loss of skeletal muscle mass, function and strength, is the result of major metabolic changes often observed in advanced liver disease. Its evaluation mirrors the nutritional and functional status of the patients, and thus has been recently implicated as an outcome predictor of patients with liver diseases and hepatocellular carcinoma. This study provides evidence that sarcopenia, as assessed by the skeletal muscle index, is associated with age and body mass index in liver surgery candidates. More importantly, it is associated with higher rates of major complications (Clavien-Dindo grade III or IV) in patients with compensated advanced chronic liver disease and/or portal hypertension undergoing liver resection for primary hepatocellular carcinoma. ABSTRACT: The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH. MDPI 2022-04-12 /pmc/articles/PMC9025609/ /pubmed/35454842 http://dx.doi.org/10.3390/cancers14081935 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marasco, Giovanni
Dajti, Elton
Serenari, Matteo
Alemanni, Luigina Vanessa
Ravaioli, Federico
Ravaioli, Matteo
Vestito, Amanda
Vara, Giulio
Festi, Davide
Golfieri, Rita
Cescon, Matteo
Renzulli, Matteo
Colecchia, Antonio
Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title_full Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title_fullStr Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title_full_unstemmed Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title_short Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis
title_sort sarcopenia predicts major complications after resection for primary hepatocellular carcinoma in compensated cirrhosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025609/
https://www.ncbi.nlm.nih.gov/pubmed/35454842
http://dx.doi.org/10.3390/cancers14081935
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