Psoas muscle index (PMI) and psoas muscle density (PMD) were associated with surgical complications in patients with perihilar cholangiocarcinoma (CCA), according to a new study published in the Journal of Hepatobiliary-Pancreatic Sciences.

The researchers highlight the importance of improving skeletal muscle mass and quality prior to surgery to achieve better outcomes.

“We sought to investigate the impact of preoperative body composition indices (especially focusing on muscle mass and muscle quality) on intraoperative bleeding, intraoperative blood transfusion, and postoperative short- and long-term outcomes in patients undergoing major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma,” they wrote. “PMI and PMD were closely associated with intraoperative blood loss and postoperative infectious complications.”

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The research team retrospectively reviewed data on 456 consecutive patients with perihilar CCA undergoing major hepatectomy with extrahepatic bile duct resection at a single center in Japan between January 2008 and December 2018. Outcomes measured included surgical time, intraoperative blood loss, need for transfusion, postoperative complications, and mortality associated with surgery.

The analysis revealed that low PMI and poor PMD were significantly associated with low levels of serum albumin and high levels of C reactive protein. Blood loss was greater and hospital stay was longer in the groups with low PMI and PMD. Low PMI was associated with a greater incidence of bacteremia, and low PMD was associated with more infectious complications. Furthermore, low PMI was found to be a risk factor for poor overall survival postsurgery.

Based on these results, the authors suspect that body composition can have a significant impact on the outcomes of patients with CCA undergoing surgery and that proactive prehabilitation in collaboration with physical therapists and nutritionists could improve short- and long-term outcomes.


Asai Y, Yamaguchi J, Mizuno T, et al. Impact of preoperative muscle mass and quality on surgical outcomes in patients undergoing major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. Published online July 21, 2022. doi:10.1002/jhbp.1220