Body composition is associated with postoperative complications in perihilar cholangiocarcinoma

Guanwu Wang; Anna Mantas; Lara R Heij; Tarick M Al-Masri; Dong Liu; Daniel Heise; Sophia M Schmitz; Steven W M Olde Damink; Tom Luedde; Sven A Lang; Tom F Ulmer; Ulf P Neumann; Jan Bednarsch

doi:10.1002/cam4.6878

Body composition is associated with postoperative complications in perihilar cholangiocarcinoma

Cancer Med. 2024 Jan 1;13(1):e6878. doi: 10.1002/cam4.6878. Online ahead of print.

Authors

Guanwu Wang¹, Anna Mantas^{1

2}, Lara R Heij^{1

3}, Tarick M Al-Masri^{1

2}, Dong Liu¹, Daniel Heise^{1

3}, Sophia M Schmitz^{1

3}, Steven W M Olde Damink⁴, Tom Luedde⁵, Sven A Lang^{1

3}, Tom F Ulmer¹, Ulf P Neumann^{1

3

4}, Jan Bednarsch^{1

3}

Affiliations

¹ Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
² University of Applied Science Aachen, Aachen, Germany.
³ Department of Surgery and Transplantation, University Hospital Essen, Essen, Germany.
⁴ Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
⁵ Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.

Abstract

Background: Perihilar cholangiocarcinoma (pCCA) is a malignant tumor of the hepatobiliary system which is still associated with a challenging prognosis. Postoperative complications play a crucial role in determining the overall prognosis of patients with pCCA. Changes in body composition (BC) have been shown to impact the prognosis of various types of tumors. Therefore, our study aimed to investigate the correlation between BC, postoperative complications and oncological outcome in patients with pCCA.

Methods: All patients with pCCA who underwent curative-intent surgery for pCCA between 2010 and 2022 were included in this analysis. BC was assessed using preoperative computed tomography and analyzed with the assistance of a 3D Slicer software. Univariate and multivariate binary logistic regression analyses were conducted to examine the relationship between BC and clinical characteristics including various measurements of postoperative complications and Cox regressions and Kaplan-Meier analysis to evaluate oncological risk factors in the study cohort.

Results: BC was frequently altered in patients undergoing curative-intent liver resection for pCCA (n = 204) with 52.5% of the patients showing obesity, 55.9% sarcopenia, 21.6% sarcopenic obesity, 48.5% myosteatosis, and 69.1% visceral obesity. In multivariate analysis, severe postoperative complications (Clavien-Dindo ≥3b) were associated with body mass index (BMI) (Odds ratio (OR) = 2.001, p = 0.024), sarcopenia (OR = 2.145, p = 0.034), and myosteatosis (OR = 2.097, p = 0.017) as independent predictors. Furthermore, sarcopenia was associated with reduced overall survival (OS) in pCCA patients (sarcopenia vs. no-sarcopenia, 21 months vs. 32 months, p = 0.048 log rank).

Conclusions: BC is highly associated with severe postoperative complications in patients with pCCA and shows tendency to be associated impaired overall survival. Preoperative assessment of BC and interventions to improve BC might therefore be key to improve outcome in pCCA patients undergoing surgical therapy.

Keywords: body composition; cholangiocellular carcinoma; oncological outcome, perioperative complications.

Abstract

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