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Sarcopenia influences the kinetic growth rate after ALPPS

  • Tim Reese
    Correspondence
    Reprint requests: Tim Reese (MD), Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany.
    Affiliations
    Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany

    Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany
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  • Clemens Galavics
    Affiliations
    Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany

    Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany
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  • Martin Schneider
    Affiliations
    Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany

    Department of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
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  • Roland Brüning
    Affiliations
    Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany

    Department of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
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  • Karl J. Oldhafer
    Affiliations
    Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany

    Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany
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      Abstract

      Background

      Associating liver partition and portal vein ligation for staged hepatectomy induces rapid and effective hypertrophy of the future liver remnant to prevent postoperative liver failure. The aim of this study was to determine cofactors, including sarcopenia, influencing the kinetic growth rate, and subsequently future liver remnant, in terms of safety, complications, and posthepatectomy liver failure.

      Method

      Patients undergoing associating liver partition and portal vein ligation for staged hepatectomy between 2010 and 2020 were included in this study. Kinetic growth rate was defined as the quotient of the degree of hypertrophy and the time interval between the 2 steps. The sarcopenia muscle index was defined as the skeletal muscle area of both psoas major muscles normalized to the patient’s height.

      Results

      During the study period, 90 patients underwent associating liver partition and portal vein ligation for staged hepatectomy. The association between kinetic growth rate and posthepatectomy liver failure indicates a significant nonlinear effect (P = .02). The incidence of posthepatectomy liver failure significantly increased at a kinetic growth rate below 7% per week (31%) compared to patients with a kinetic growth rate >7%/wk (7%, P = .02). In patients with a low kinetic growth rate (<7%/wk), the sarcopenia muscle index was significantly lower compared to patients with a high kinetic growth rate (>7%/wk). Furthermore, a low sarcopenia muscle index and a high body mass index turned out to be independent risk factors for a low kinetic growth rate.

      Conclusion

      After the first step of the associating liver partition and portal vein ligation for staged hepatectomy procedure, a low kinetic growth rate (<7%/wk) increases the risk of posthepatectomy liver failure. The presence of a low sarcopenia muscle index and a high body mass index are profoundly correlated with clinically substantial impaired liver regeneration, which can result in increased liver dysfunction after associating liver partition and portal vein ligation for staged hepatectomy.
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