Elsevier

Surgery

Volume 159, Issue 3, March 2016, Pages 821-833
Surgery

Hepatobiliary
Impact of the preoperative quantity and quality of skeletal muscle on outcomes after resection of extrahepatic biliary malignancies

https://doi.org/10.1016/j.surg.2015.08.047Get rights and content

Background

Skeletal muscle depletion, referred to as sarcopenia, predicts mortality after major surgery. This study investigated the impact of preoperative skeletal muscle quantity and quality on outcomes in patients undergoing resection of extrahepatic biliary cancer.

Methods

We performed a retrospective analysis of 207 patients undergoing resection for biliary cancer between 2004 and 2013. The quantity and quality of skeletal muscle, indicated by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), were measured on preoperative images of computed tomography. Overall survival (OS) and recurrence-free survival (RFS) rates were compared by PMI and IMAC, and prognostic factors after operation were assessed.

Results

The OS and RFS rates were less in patients with low PMI (low muscle quantity) than in those with normal PMI (P < .001 and P < .001; 5-year OS, 15.7 vs 53.5%). The OS and RFS rates were also less in patients with high IMAC (low muscle quality) than in those with normal IMAC (P < .001 and P < .001; 5-year OS, 23.8 vs 55.9%). Low PMI and high IMAC were independent factors predictive of poor OS (hazard ratio [HR], 2.921 [95% CI, 1.920–4.470; P < .001] and HR, 1.725 [95% CI, 1.159–2.590; P = .007]) and RFS (HR, 2.141 [95% CI, 1.464–3.129, P < .001] and HR, 1.492 [95% CI, 1.032–2.166, P = .034]).

Conclusion

Preoperative sarcopenia, indicating a low quantity and quality of skeletal muscle, is related closely to mortality after resection of biliary cancer.

Section snippets

Patients and data collection

A total of 219 consecutive patients underwent resection for extrahepatic biliary cancer with curative intent between January 2004 and December 2013 at Kyoto University. The patients with stage 0 (n = 6) and those who underwent only cholecystectomy (n = 6) were excluded; 207 patients were included in this study. There were 111 men (53.6%) and 96 women (46.4%), and their median age was 68 years (range, 33–85). The locations of the tumor were perihilar bile duct cancer, distal extrahepatic bile

Correlations of PMI and IMAC with patient sex

PMI was greater in males (median, 6.89 cm2/m2; range, 3.39–11.66) than in females (median, 4.49 cm2/m2; range, 2.30–8.07 P < .001), whereas the IMAC was less in males (median, −0.358; range, −0.615 to 0.210) than in females (median, −0.130; range, −0.551 to 0.301; P < .001).

Preoperative characteristics of patients classified by PMI

Preoperative clinicopathologic characteristics of patients with low and normal PMI are shown in Table I. Patients with low PMI were significantly older than those with normal PMI (P = .002). BMI was less in patients with low

Discussion

The results of this retrospective study showed that preoperative PMI and IMAC are independent risk factors for mortality after resection of extrahepatic biliary cancer. To the best of our knowledge, this is the first study to investigate the impact of skeletal muscle mass and quality on survival after resection of extrahepatic biliary cancer.

In the present study, 2 parameters reflecting the quantity (PMI) and quality (IMAC) of skeletal muscle were investigated. Previously, skeletal muscle mass

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    No financial support was received from any source for this study.

    The authors declare that there are no conflicts of interest in relation to this study.

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