Z Gastroenterol 2020; 58(08): e202
DOI: 10.1055/s-0040-1716278
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Skeletal muscle index by CT correlates with kinetic growth and resectability after PVE

J Heil
1   Institute of Physiology, Zürich, Schweiz
2   University of Frankfurt, General and Visceral Surgery, Frankfurt, Deutschland
,
F Heid
1   Institute of Physiology, Zürich, Schweiz
3   Cantonal Hospital Winterthur, General and Visceral Surgery, Winterthur, Schweiz
,
B Björnsson
4   Linköping University, Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping, Schweden
,
WO Bechstein
2   University of Frankfurt, General and Visceral Surgery, Frankfurt, Deutschland
,
T Brismar
5   Karolinska Institute, Clinical Science and Technology (CLINTEC), Radiology Unit, Stockholm, Schweden
,
U Carling
6   Oslo University Hospital, Radiology and Nuclear Medicine, Oslo, Norwegen
,
Å Fretland
7   Oslo University Hospital, Hepato-Pancreatic-Biliary surgery, Oslo, Norwegen
,
RA Hana
8   McGill University, Diagnostic Radiology, Montreal, Kanada
,
R Linke
2   University of Frankfurt, General and Visceral Surgery, Frankfurt, Deutschland
,
Y Meyer
9   Erasmus Medical Center Cancer Institute, Surgical Oncology, Rotterdam, Niederlande
,
A Nawawi
10   McGill UniversityGill University, McGill Health Center Research Institute, Cancer Program, Montreal, Kanada
,
AA Schnitzbauer
2   University of Frankfurt, General and Visceral Surgery, Frankfurt, Deutschland
,
E Sparrelid
11   Division of Surgery, Karolinska Institute, Karolinska Hospital, Clinical Science, Intercention and Technology, Stockholm, Schweden
,
P Metrakos
10   McGill UniversityGill University, McGill Health Center Research Institute, Cancer Program, Montreal, Kanada
,
K Verhoef
9   Erasmus Medical Center Cancer Institute, Surgical Oncology, Rotterdam, Niederlande
,
E Schadde
1   Institute of Physiology, Zürich, Schweiz
3   Cantonal Hospital Winterthur, General and Visceral Surgery, Winterthur, Schweiz
12   Rush University Medical Center, General and Visceral Surgery, Chicago, Vereinigte Staaten von Amerika
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Introduction Techniques to increase the future liver remnant (FLR) prior to resection expand resectability of borderline resectable liver tumors. After portal vein embolization (PVE), only 60-70% of resections are feasible. Liver growth after PVE has been shown to be impacted by age, cirrhosis, diabetes and cholestasis. Malnutrition is associated with a smaller total liver volume and worse outcomes after liver resection. Skeletal muscle index (SMI) is an objective measure of malnutrition obtained from cross-sectional imaging.

Aim This study investigates, if a low SMI predicts a low KGR after PVE and thereby reduces feasibility of resection.

Methods All patients requiring PVE and planned for liver surgery were retrospectively analysed at 6 international centers in the DRAGON collaborative between 2010 and 2019. MRI and CT scans were used to assess liver volumetry and SMI was measured at the third lumbar vertebrae (L3) on pre-operative scans using the software OsiriX MD, Version 11.0.2. Total liver volume was calculated by Vauthey’s formula to assess standardized FLR (sFLR). Factors with impact on KGR were assessed and a multi-variate analysis was performed using stepwise regression.

Results Two hundred and ninety-three patients underwent PVE and were planned for liver surgery. Overall 254 patients (87%) were included in the analysis. Mean age was 63 years. Gender distribution was 107:147 (m:f). After a median of 27 days (IQR 21-31) the sFLR1 increases from 21% (IQR 16-27) to a sFLR2 of 30% (IQR 23-40). Median degree of hypertrophy was 41

(IQR 24-66) and median KGR was 2.02 (IQR 1.2-3.5). SMI correlates with KGR (p = 0.01). In a multi-variate analysis, pre-operative creatinine elevation and low SMI are the significant risk factors for a low KGR. Patients with a SMI of more than 41.5 cm2/m2 had a higher chance undergoing resection (90% vs. 72%, p <  0.001).

Conclusion Of the known factors impacting on KGR, low SMI and renal dysfunction correlate with KGR and predict resectability. A prospective study is needed to analyse if nutritional intervention improves resectability of patients with borderline resectable liver tumors.



Publication History

Article published online:
08 September 2020

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