Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients

Abstract

Background and aims: Intrahepatic cholangiocarcinoma (iCC) is an aggressive tumor, usually detected at an advanced stage. Our aim was to investigate the potential of body composition analysis (BCA) derived from presurgical staging computed tomography (CT) in predicting perisurgical complications.

Methods: In this retrospective cohort study, we enrolled 86 patients who underwent CT imaging prior to liver surgery. Cox and logistic regression were performed to assess risk factors for prolonged hospital and intensive care unit (ICU) stays, as well as the occurrence of various complications. BCA parameters served as covariates besides conventional risk factors.

Results: Postoperative complications after resection of iCC significantly prolonged the overall length of hospitalization (p < .001). Presence of sarcopenia was associated with longer ICU stays. Complications were common, with 62.5% classified as Clavien-Dindo grade IIIa or lower and 37.5% as more severe. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were identified as risk factors for complications, including bile leakage (in 24 cases, p = .025), pleural effusions (in 26 cases, p = .025), and intra-abdominal abscess formation (in 24 cases, p = .043). SAT was associated with severe complications requiring interventional therapy, whereas VAT was correlated with abscess formation. Despite normal prevalence of obesity (22%), body mass index (BMI) did not have an impact on the development of perioperative complications.

Conclusion: BCA is a useful tool for preoperative risk stratification in patients with iCC and is superior to BMI assessment. Increased SAT and VAT were associated with the risk of perisurgical complications, prolonging hospitalization. Therefore, BCA derived from routine staging CT should be considered in the preoperative assessment of patients with iCC.

Keywords: artificial intelligence; body composition analysis; computed tomography; intrahepatic cholangiocarcinoma; liver surgery; perisurgical complications.

FIGURE 1

Two examples of automated PACS‐integrated body composition analysis. Each segmented tissue is coded with a different color: psoas muscle = purple, skeletal muscle (without psoas muscle) = green, visceral fat = dark green, and subcutaneous fat = blue. Tissue density and area are automatically calculated using Visage version 7.1. Even though the two patients have the same body mass index of 30, their body composition analysis reveals obvious differences in tissue distribution, with patient (A) showing a relatively greater muscle area, whereas patient (B) has a higher proportion of subcutaneous adipose tissue.

FIGURE 2

Kaplan–Meier curves of hospital length of stay of patients with and without postoperative complications after curative‐intended liver surgery. Hospitalization is significantly prolonged in patients with complications (p < .001).