# Association Between Preoperative Sarcopenia and Postoperative Complications Following Hepatopancreatobiliary Cancer Surgery at a Tertiary Care Center in Eastern India

## TL;DR

This study shows that low muscle mass before surgery for liver and pancreatic cancer is linked to more postoperative complications and infections.

## Contribution

The study provides new evidence from India on how sarcopenia affects surgical outcomes in hepatopancreatobiliary cancer patients.

## Key findings

- Sarcopenic patients had a significantly higher rate of total postoperative complications (95.45%) compared to non-sarcopenic patients (67.76%).
- Infective complications were more common in sarcopenic patients (45.45%) than in non-sarcopenic patients (16.12%).
- Sarcopenia was identified as a significant predictor of both total and infective postoperative complications.

## Abstract

Background

Postoperative morbidity continues to be a significant concern in hepatopancreatobiliary (HPB) cancer surgeries despite advances in surgical and perioperative care. Sarcopenia, defined as the loss of skeletal muscle mass and strength, has emerged as an important predictor of poor surgical outcomes. Limited data from India exist regarding its impact on postoperative complications and infections in HPB cancer patients. This study aimed to evaluate the association between preoperative sarcopenia and postoperative morbidity in patients undergoing HPB cancer surgeries.

Methods

A prospective observational study was conducted at the Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, India, between January 2022 and June 2023. Fifty-three patients aged 18-85 years with operable HPB malignancies were included. Sarcopenia was assessed preoperatively using anthropometric measures (mid-arm circumference and handgrip strength) and computed tomography (CT)-derived skeletal muscle index (SMI) at the L3 vertebral level. The cut-off for sarcopenia was defined as <36.5 cm2/m2 in males and <30.2 cm2/m2 in females. Postoperative outcomes such as total complications, infective complications, ICU stay, hospital stay, and 30-day mortality were recorded. Statistical analysis was performed using the Mann-Whitney U test, Fisher’s exact test, and univariate logistic regression, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

Of the 53 patients, 22 (41.5%) were diagnosed with sarcopenia. No in-hospital mortality or immediate postoperative complications occurred. The total postoperative complication rate was significantly higher in the sarcopenic group (95.45%) compared to the nonsarcopenic group (67.76%; p = 0.014). Infective complications were also more prevalent among sarcopenic patients (45.45%) than nonsarcopenic patients (16.12%; p = 0.019). Univariate analysis identified sarcopenia as a significant predictor of both total postoperative complications (OR = 10.00, p = 0.035) and infective complications (OR = 3.06, p = 0.016).

Discussion

The findings of this study demonstrate that sarcopenia is a key determinant of postoperative morbidity and infection in patients undergoing HPB cancer surgeries. The association between reduced skeletal muscle mass and adverse outcomes may be explained by impaired immune response, reduced metabolic reserve, and delayed tissue recovery in sarcopenic patients. These results are consistent with previous international studies showing higher postoperative complication rates among sarcopenic individuals. Furthermore, the strong correlation between low handgrip strength and infection risk reinforces the importance of assessing both muscle quantity and function in the preoperative setting. The high prevalence of sarcopenia in this study population highlights the need for early recognition, particularly in older adults and those with malignancy-related cachexia.

Conclusion

Sarcopenia is strongly associated with increased postoperative morbidity and infection in HPB cancer surgery. Preoperative identification and targeted prehabilitation strategies focusing on nutrition and muscle strengthening may improve surgical outcomes and enhance recovery in high-risk patients.