Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial.

Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy.

Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3).

Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14-1.63; p = 0.0008; I2 = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15-1.58; p = 0.0002; I2 = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14-1.73; p = 0.002; I2 = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28-2.09; p < 0.0001; I2 = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied.

Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.