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Body composition as reflected by intramuscular adipose tissue content may influence short- and long-term outcome following 2-stage liver resection for colorectal liver metastases

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Abstract

Introduction

For many kinds of cancer, body composition and immunonutritional status have been reported to influence postoperative outcome. We assessed their impact on short- and long-term outcome in patients with colorectal liver metastases who underwent 2-stage liver resections.

Methods

Short- and long-term outcomes for 47 patients with 2-stage hepatectomies were assessed retrospectively in terms of data obtained before preoperative chemotherapy, before the first hepatectomy, and before the second hepatectomy.

Results

Although immunonutritional status and body composition did not affect short-term outcome, high intramuscular fat content before the second hepatectomy was a poor prognostic factor for overall survival (HR, 5.829; 95% CI, 1.611–21.090; p = 0.007) and for recurrence-free survival (HR, 2.787; 95% CI, 1.301–5.973; p = 0.008). Patients with high intramuscular fat before the second hepatectomy also showed shorter intervals from recurrence to treatment failure.

Conclusion

Intramuscular fat before the second hepatectomy is an important negative prognosticator in 2-stage liver resection for colorectal liver metastases.

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Abbreviations

ALPPS:

Associating liver partition and portal vein occlusion for staged hepatectomy

BMI:

Body mass index

CI:

Confidence interval

CRLM:

Colorectal liver metastases

CT:

Computed tomography

FLR:

Future liver remnant

HR:

Hazard ratio

ICGR15:

Indocyanine green retention rate at 15 min

IMAC:

Intramuscular adipose tissue content

ISGLS:

International Study Group of Liver Surgery

NLR:

Neutrophil-lymphocyte ratio

OS:

Overall survival

PNI:

Prognostic nutritional index

pre-CTx:

Before neoadjuvant chemotherapy

pre-Hx1:

Before the first operation

pre-Hx2:

Before the second operation

PVE:

Portal vein embolization

RFS:

Recurrence-free survival

ROC:

Receiver operating characteristic

ROI:

Region of interest

SMI:

Skeletal muscle index

TSH:

2-stage hepatectomy

TTF:

Time to treatment failure

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan

    Toshimitsu Shiozawa, Tetsuji Wakabayashi, Kenichi Matsuo, Yuki Takahashi & Kuniya Tanaka

  2. Department of Surgery, Division of Hepato-biliary-pancreatic Surgery, Teikyo University Chiba Medical Center, Chiba, Japan

    Yutaro Kikuchi, Kenichi Matsuo & Kuniya Tanaka

  3. Departments of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Yutaro Kikuchi

  4. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Kuniya Tanaka

Authors
  1. Toshimitsu Shiozawa
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  2. Yutaro Kikuchi
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  3. Tetsuji Wakabayashi
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  4. Kenichi Matsuo
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  5. Yuki Takahashi
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Contributions

Design: Tanaka. Acquisition of data: Shiozawa, Kikuchi, Wakabayashi, and Takahashi. Analysis and interpretation of data: Kikuchi, Wakabayashi, and Takahashi. Drafting the article: Shiozawa. Revising the article: Tanaka and Matsuo. Final approval: Tanaka.

Corresponding author

Correspondence to Kuniya Tanaka.

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The authors declare that they have no conflicts of interest.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Shiozawa, T., Kikuchi, Y., Wakabayashi, T. et al. Body composition as reflected by intramuscular adipose tissue content may influence short- and long-term outcome following 2-stage liver resection for colorectal liver metastases. Langenbecks Arch Surg 405, 757–766 (2020). https://doi.org/10.1007/s00423-020-01973-1

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