Preoperative Sarcopenia Negatively Impacts Postoperative Outcomes Following Major Hepatectomy with Extrahepatic Bile Duct Resection

Major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma remains a highly morbid procedure. The association between preoperative sarcopenia and postoperative morbidity/mortality has been reported for various types of surgeries. The objective was to analyze the relationship between preoperative sarcopenia and postoperative morbidity/mortality in patients who underwent major hepatectomy with extrahepatic bile duct resection. This study included 256 patients who underwent major hepatectomy with extrahepatic bile duct resection from 2008 to 2014. Preoperative sarcopenia was assessed by a measurement of the total psoas muscle area (TPA). The measured TPA was normalized by height. Preoperative sarcopenia was defined as the presence of a normalized TPA in the lowest sex-specific tertile. A total of 54 males and 31 females were determined to have preoperative sarcopenia. The length of the postoperative hospital stay for patients with sarcopenia was significantly longer than for those without sarcopenia (39 vs 30 days, p < 0.001). Patients with sarcopenia experienced a significantly higher rate of liver failure (ISGLS grade a parts per thousand yen B) (33 vs 16 %), major complications with Clavien grade a parts per thousand yen 3 (54 vs 37 %), and intra-abdominal abscess (29 vs 18 %) than those without sarcopenia (all p < 0.05). After a multivariate analysis, low normalized TPA (male < 567 mm(2)/m(2); female < 395 mm(2)/m(2)) was identified as an independent risk factor for the development of liver failure (odds ratio 2.46). This study demonstrated that preoperative sarcopenia increased the morbidity rate including the rate of liver failure, in patients who underwent major hepatectomy with extrahepatic bile duct resection.