Impact of body composition on survival and morbidity after liver resection in hepatocellular carcinoma patients

Background: Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk stratification. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepatocellular carcinoma. Methods: A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level(L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated. Results: Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic( P = 0.035) and sarcopenic obese( P = 0.048) patients as well as a trend favoring obese( P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival. Conclusions: Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients.

Liver transplantation in malignant disease

Liver transplantation for malignant disease has gained increasing attention as part of transplant oncology.Following the implementation of the Milan criteria,hepatocellular carcinoma(HCC)was the first generally accepted indication for transplantation in patients with cancer.Subsequently,more liberal criteria for HCC have been developed,and research on this topic is still ongoing.The evident success of liver transplantation for HCC has led to the attempt to extend its indication to other malignancies.Regarding perihilar cholangiocarcinoma,more and more evidence supports the use of liver transplantation,especially after neoadjuvant therapy.In addition,some data also show a benefit for selected patients with very early stage intrahepatic cholangiocarcinoma.Hepatic epithelioid hemangioendothelioma is a very rare but nonetheless established indication for liver transplantation in primary liver cancer.In contrast,patients with hepatic angiosarcoma are currently not considered to be optimal candidates.In secondary liver tumors,neuroendocrine cancer liver metastases are an accepted but comparability rare indication for liver transplantation.Recently,some evidence has been published supporting the use of liver transplantation even for colorectal liver metastases.This review summarizes the current evidence for liver transplantation for primary and secondary liver cancer.

Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients

BACKGROUND Laparoscopic liver surgery is currently considered the standard of care for various liver malignancies.However,studies focusing on perioperative outcome after laparoscopic hepatectomy(LH)in overweight patients are still sparse and its benefit compared to open hepatectomy(OH)is a matter of debate.AIM To analyze postoperative outcomes in overweight[body mass index(BMI)over 25 kg/m²]and obese(BMI over 30 kg/m²)patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODS Perioperative data of 68 overweight(BMI over 25 kg/m²)including a subcohort of obese(BMI over 30 kg/m²)patients(n=27)who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTS The mean BMI was 29.8±4.9 kg/m2 in the LH group and 29.7±3.6 kg/m2 in the OH group with major resections performed in 20.6%(LH)and 26.5%(OH)of cases,respectively.Operative time(194±88 min vs 275±131 min;P<0.001)as well as intensive care(0.8±0.7 d vs 1.1±0.8 d;P=0.031)and hospital stay(7.3±3.6 d vs 15.7±13.5 d;P<0.001)were significant shorter in the LH group.Also,overall complications(20.6%vs 45.6%;P=0.005)and major complications(1.5%vs 14.7%,P=0.002)were observed less frequently after LH.An additional investigation analyzing the subgroup of obese patients who underwent LH(n=27)and OH(n=29)showed a shorter operative time(194±81 min vs 260±137 min;P=0.009)and a reduced length of hospitalization(7.7±4.3 d vs 17.2±17 d;P<0.001)but no difference in postoperative complications or overall cost.CONCLUSION LH is safe and cost-effective in overweight and obese patients.Furthermore,LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.

WoRMS needs YOU!A Reply to Collareta et al.2020

Editorial Note:“This response to Collareta et al.(2020)was reviewed by several taxonomists,all who expressed a degree of misgiving about the editorial processes and protocols involved in the revision of the Thoracica and publication of this revision in WoRMS.It is critical that future editors ensure that any taxonomic revision is supported by peer-reviewed publication.”