Association of Sarcopenia With Short-Term Outcomes After Liver Resection for Malignant Tumors

Abstract

Background: Sarcopenia, characterised by reduced skeletal muscle mass, is increasingly recognised as a determinant of postoperative morbidity in patients with malignancy. Evidence regarding its association with short-term outcomes after liver resection for malignant tumours remains limited in Bangladesh. Objective: This study determined the association between preoperative sarcopenia and short-term postoperative outcomes in patients undergoing liver resection for malignant tumours. Methods: This prospective observational study was conducted in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangladesh Medical University, from July 2024 to June 2025. Sarcopenia was assessed on preoperative non-contrast CT at the third lumbar vertebral (L3) level. Skeletal muscle area was normalised for height to calculate the L3 skeletal muscle index (SMI). Sex-specific SMI cutoffs of ≤52.4 cm²/m² for men and ≤38.5 cm²/m² for women were used. Demographic, perioperative, and short-term postoperative outcomes were compared between sarcopenic and non-sarcopenic groups. Results: Twenty-seven patients were analysed; 15 (55.6%) were classified as sarcopenic and 12 (44.4%) as non-sarcopenic. The median postoperative hospital stay was longer in the sarcopenic group than in the non-sarcopenic group (14-16 vs. 7-9 days; Mann-Whitney U=180.0; rank-biserial correlation=1.00; p<0.001). Infectious complications occurred in 9/15 (60.0%) sarcopenic patients and 2/12 (16.7%) non-sarcopenic patients, corresponding to an OR of 7.50 (95% CI: 1.20-47.05; Fisher exact p=0.047). Operative time and intraoperative blood loss were not significantly different. No postoperative haemorrhage, bile leakage, liver failure, reoperation, 30-day readmission, or mortality was recorded. Conclusion: Preoperative sarcopenia was common and was associated with prolonged hospitalisation and a higher incidence of postoperative infectious complications. Preoperative assessment of skeletal muscle status may identify patients who could benefit from nutritional optimisation and physical prehabilitation.