This study aimed to investigate the incidence of newly developed sarcopenia at discharge following liver cancer surgery, identify associated background factors, and assess changes in physical function at one-month postoperatively.
Consecutive patients diagnosed with primary liver cancer who underwent surgery at our institution between November 2019 and November 2023 were included. Patients with preoperative sarcopenia, those who died within one-month post-surgery, and those with incomplete follow-up were excluded. The factors assessed included age, sex, Charlson Comorbidity Index (CCI), liver cancer stage, surgical method (laparoscopic or open), intraoperative blood loss, Clavien-Dindo classification, and length of hospital stay. Body composition was evaluated using the body mass index (BMI), skeletal muscle mass index (SMI), and phase angle (PA). Physical function was measured preoperatively and one month postoperatively, including the 6-min walk distance (6 MWD), handgrip strength, and 4-m gait speed (4MGS). Sarcopenia was evaluated preoperatively, at discharge, and one month postoperatively. Statistical analysis compared patients who developed sarcopenia at discharge with those who did not develop sarcopenia.
A total of 40 patients (mean age: 69.8 ± 9.5 years; 67.5% male) were analyzed. Sarcopenia developed in five patients (12.5%) at discharge. One month postoperatively, eight patients (20.0%) had sarcopenia, and all five patients who developed sarcopenia at discharge remained sarcopenia. Patients who developed sarcopenia at discharge were older (81.0 vs 68.0 years, p=0.004), had a lower preoperative BMI (21.7 vs 24.2 kg/m², p=0.05), and had more advanced liver cancer (p=0.017) than those who did not develop sarcopenia. No significant differences were observed in the other baseline factors. There were no significant differences in preoperative physical function between the two groups; however, patients who developed sarcopenia at discharge had significantly slower 4MGS (0.86 vs 1.11 m/s, p=0.017) and shorter 6 MWD (411.0 vs 500.0 m, p=0.006) one month postoperatively.
The incidence of newly developed sarcopenia at discharge following liver cancer surgery was 12.5%, and all affected patients remained sarcopenic one month later. Sarcopenia onset is associated with older age, lower BMI, and more advanced stages of liver cancer.
Preventive strategies during hospitalization, postoperative guidance, and continued outpatient physiotherapy are crucial for mitigating the physical decline associated with sarcopenia. Future studies with larger sample sizes are required to validate these findings.
Liver cancer surgery
Postoperative physical function
