Effect of sarcopenia on postoperative ICU admission and length of stay after hepatic resection for Klatskin tumor

Hyun Eom Jung; Dai Hoon Han; Bon-Nyeo Koo; Jeongmin Kim

doi:10.3389/fonc.2023.1136376

Effect of sarcopenia on postoperative ICU admission and length of stay after hepatic resection for Klatskin tumor

Front Oncol. 2023 Mar 9:13:1136376. doi: 10.3389/fonc.2023.1136376. eCollection 2023.

Authors

Hyun Eom Jung¹, Dai Hoon Han², Bon-Nyeo Koo¹, Jeongmin Kim¹

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

Background: Hepatic resection of Klatskin tumors usually requires postoperative intensive care unit (ICU) admission because of its high morbidity and mortality. Identifying surgical patients who will benefit most from ICU admission is important because of scarce resources but remains difficult. Sarcopenia is characterised by the loss of skeletal muscle mass and is associated with poor surgical outcomes.

Methods: We retrospectively analysed th.e relationship between preoperative sarcopenia and postoperative ICU admission and length of ICU stay (LOS-I) in patients who underwent hepatic resection for Klatskin tumors. Using preoperative computed tomography scans, the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra was measured and normalised to the patient's height. Using these values, the optimal cut-off for diagnosing sarcopenia was determined using receiver operating characteristic curve analysis for each sex.

Results: Of 330 patients, 150 (45.5%) were diagnosed with sarcopenia. Patients with preoperative sarcopenia presented significantly more frequently to the ICU (77.3% vs. 47.9%, p < 0.001) and had longer total LOS-I (2.45 vs 0.89 days, p < 0.001). Moreover, patients with sarcopenia showed a significantly higher postoperative length of hospital stay, severe complication rate, and in-hospital mortality.

Conclusions: Sarcopenia correlated with poor postoperative outcomes, especially with the increased requirement of postoperative ICU admission and prolonged LOS-I after hepatic resection in patients with Klatskin tumors.

Keywords: Klatskin tumor; hepatectomy; intensive care unit; perihilar cholangiocarcinoma; sarcopenia.

Grants and funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education (NRF-2020R1A2C1012166 to BK).