Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection - A DRAGON collaborative analysis of 306 patients

Jan Heil; Franziska Heid; Wolf O Bechstein; Bergthor Björnsson; Torkel B Brismar; Ulrik Carling; Joris Erdmann; Åsmund A Fretland; Dirk Grunhagen; Renato A Hana; Joachim Hohmann; Richard Linke; Yannick Meyer; Abrar Nawawi; Pim B Olthof; Per Sandström; Andreas A Schnitzbauer; Ernesto Sparrelid; Cornelis Verhoef; Peter Metrakos; Erik Schadde

doi:10.1016/j.hpb.2021.08.818

Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection - A DRAGON collaborative analysis of 306 patients

HPB (Oxford). 2022 Mar;24(3):413-421. doi: 10.1016/j.hpb.2021.08.818. Epub 2021 Aug 16.

Authors

Jan Heil¹, Franziska Heid², Wolf O Bechstein³, Bergthor Björnsson⁴, Torkel B Brismar⁵, Ulrik Carling⁶, Joris Erdmann⁷, Åsmund A Fretland⁸, Dirk Grunhagen⁹, Renato A Hana¹⁰, Joachim Hohmann¹¹, Richard Linke³, Yannick Meyer⁹, Abrar Nawawi¹², Pim B Olthof¹³, Per Sandström⁴, Andreas A Schnitzbauer³, Ernesto Sparrelid¹⁴, Cornelis Verhoef⁹, Peter Metrakos¹², Erik Schadde¹⁵

Affiliations

¹ Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany.
² Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.
³ Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany.
⁴ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁵ Department of Clinical Science and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Radiology Rikshospitalet, Oslo University Hospital, Oslo, Norway.
⁷ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁸ Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway.
⁹ Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands.
¹⁰ Department of Diagnostic Radiology, McGill General Hospital, Montreal, Canada.
¹¹ Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland.
¹² Department of Surgery, McGill Health Center Research Institute, Cancer Program, Montreal, Canada.
¹³ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands.
¹⁴ Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden.
¹⁵ Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland; Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: erik.schadde@icloud.com.

PMID: 34526229
DOI: 10.1016/j.hpb.2021.08.818

Abstract

Background: After portal vein embolization (PVE) 30% fail to achieve liver resection. Malnutrition is a modifiable risk factor and can be assessed by radiological indices. This study investigates, if sarcopenia affects resectability and kinetic growth rate (KGR) after PVE.

Methods: A retrospective study was performed of the outcome of PVE at 8 centres of the DRAGON collaborative from 2010 to 2019. All malignant tumour types were included. Sarcopenia was defined using gender, body mass and skeletal muscle index. First imaging after PVE was used for liver volumetry. Primary and secondary endpoints were resectability and KGR. Risk factors impacting liver growth were assessed in a multivariable analysis.

Results: Eight centres identified 368 patients undergoing PVE. 62 patients (17%) had to be excluded due to unavailability of data. Among the 306 included patients, 112 (37%) were non-sarcopenic and 194 (63%) were sarcopenic. Sarcopenic patients had a 21% lower resectability rate (87% vs. 66%, p < 0.001) and a 23% reduced KGR (p = 0.02) after PVE. In a multivariable model dichotomized for KGR ≥2.3% standardized FLR (sFLR)/week, only sarcopenia and sFLR before embolization correlated with KGR.

Conclusion: In this largest study of risk factors, sarcopenia was associated with reduced resectability and KGR in patients undergoing PVE.

MeSH terms

Embolization, Therapeutic* / adverse effects
Embolization, Therapeutic* / methods
Hepatectomy / adverse effects
Hepatectomy / methods
Humans
Liver / diagnostic imaging
Liver / surgery
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / surgery
Portal Vein / surgery
Retrospective Studies
Sarcopenia* / complications
Sarcopenia* / diagnostic imaging
Treatment Outcome