Abstract
BACKGROUND: Sarcopenia is increasingly recognized as a major prognostic factor in liver surgery. The present study aimed to investigate the impact of preoperative sarcopenia on postoperative morbidity and mortality following major hepatectomy for malignant liver tumours. METHODS: The present retrospective cohort study included 104 patients who underwent major hepatectomy between 2019 and 2024. Sarcopenia was assessed using preoperative computed tomography scans to calculate the L3 skeletal muscle index (L3-SMI), with established sex-specific cut-offs. Postoperative outcomes were compared between sarcopenic and nonsarcopenic patients. RESULTS: Of the 104 patients, 56 (53.8%) were classified as having sarcopenia. Sarcopenic patients had a significantly lower Body mass ındex (26.4 ± 3.7 vs. 28.4 ± 4.0 kg/m²; p = 0.011) and a greater proportion of males (71.4% vs. 41.7%; p = 0.002). Although there was a higher rate of postoperative morbidity in sarcopenic patients (55.3% vs. 39.6%), the difference did not reach statistical significance (p = 0.108). No significant differences were found in 90-day mortality (10.7% vs. 12.5%, p = 0.776) or long-term mortality (66.1% vs. 58.3%, p = 0.416) between the groups. CONCLUSION: Preoperative sarcopenia is associated with a higher risk of postoperative morbidity following major hepatectomy. However, preoperative sarcopenia does not significantly affect short-term or long-term mortality. Routine assessment of muscle mass should be considered in preoperative evaluations to identify vulnerable patients and tailor perioperative management strategies.