Prognostic Significance of Sarcopenia in Patients Undergoing Surgery for Perihilar Cholangiocarcinoma: A Systematic Review and Meta-Analysis.

Aim: The aim of this study was to determine the impact of sarcopenia on outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma.

Methods: A systematic review and meta-analysis following PRISMA standards were conducted, searching for studies comparing patients with and without sarcopenia undergoing surgery for perihilar cholangiocarcinoma. The outcomes included postoperative mortality, Clavien-Dindo ≥ 3 complications, intraoperative blood loss, need for blood transfusion, length of hospital stay, and overall survival (OS) (time-to-event). The odds ratio (OR), mean difference (MD), and adjusted hazard ratio (HR) were calculated as summary measures using random effect modelling. Risk of bias was assessed with the Quality in Prognosis Studies tool.

Results: Five studies featuring 1304 patients were included. There was no significant difference in postoperative mortality (OR 1.85, 95% CI 0.75-4.57, = 0.18), Clavien-Dindo ≥ 3 complications (OR 1.44, 95% CI 0.92-2.25, = 0.11), length of hospital stay (MD 2.13 days, 95% CI -0.89-5.15, = 0.17) or OS (adjusted HR 1.48, 95% CI, 0.97-2.28, = 0.07) between the patients with and without sarcopenia. Sarcopenia increased intraoperative blood loss (MD 388.00 mL, 95% CI, 114.99-683.01, = 0.006) and the need for blood transfusion (OR 2.27, 95% CI, 1.66, 3.10, < 0.00001).

Conclusions: Sarcopenia may increase the risk of bleeding during the resection of perihilar cholangiocarcinoma (low certainty); however, this may not translate into a higher risk of postoperative morbidity or mortality (moderate certainty). Our findings regarding the OS may be subject to type 2 error; hence, the effect of sarcopenia on long-term outcomes after the resection of perihilar cholangiocarcinoma remains unknown and requires further research.