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

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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 ( IF 2.7 ) Pub Date : 2021-08-16 , DOI: 10.1016/j.hpb.2021.08.818
Jan Heil ₁ , Franziska Heid ₂ , Wolf O Bechstein ₃ , Bergthor Björnsson ₄ , Torkel B Brismar ₅ , Ulrik Carling ₆ , Joris Erdmann ₇ , Åsmund A Fretland ₈ , Dirk Grunhagen ₉ , Renato A Hana ₁₀ , Joachim Hohmann ₁₁ , Richard Linke ₃ , Yannick Meyer ₉ , Abrar Nawawi ₁₂ , Pim B Olthof ₁₃ , Per Sandström ₄ , Andreas A Schnitzbauer ₃ , Ernesto Sparrelid ₁₄ , Cornelis Verhoef ₉ , Peter Metrakos ₁₂ , Erik Schadde ₁₅

Affiliation

Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany.
Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.
Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Main, Germany.
Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Clinical Science and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Radiology Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Hepato-Pancreatic-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway.
Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands.
Department of Diagnostic Radiology, McGill General Hospital, Montreal, Canada.
Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland.
Department of Surgery, McGill Health Center Research Institute, Cancer Program, Montreal, Canada.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands.
Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden.
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.

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.

中文翻译：

肌肉减少症预示肝切除前接受门静脉栓塞术的患者肝脏生长减少和可切除性降低 - 306 名患者的 DRAGON 协作分析

背景

门静脉栓塞 (PVE) 后 30% 未能实现肝切除。营养不良是一个可改变的风险因素，可以通过放射学指标进行评估。本研究调查了肌肉减少症是否会影响 PVE 后的可切除性和动态生长率 (KGR)。

方法

对 2010 年至 2019 年 DRAGON 合作的 8 个中心的 PVE 结果进行了回顾性研究。包括所有恶性肿瘤类型。肌肉减少症是使用性别、体重和骨骼肌指数来定义的。PVE 后的第一次成像用于肝脏体积测定。主要和次要终点是可切除性和 KGR。在多变量分析中评估了影响肝脏生长的危险因素。

结果

八个中心确定了 368 名接受 PVE 的患者。由于数据不可用，62 名患者 (17%) 不得不被排除在外。在纳入的 306 名患者中，112 名 (37%) 为非少肌症，194 名 (63%) 为少肌症。少肌症患者在 PVE 后可切除率降低 21%（87%对66%，p < 0.001），KGR 降低 23%（p = 0.02）。在 KGR ≥2.3% 标准化 FLR (sFLR)/周的多变量模型中，只有肌肉减少症和栓塞前的 sFLR 与 KGR 相关。