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,p= 0.18), Clavien–Dindo ≥ 3 complications (OR 1.44, 95% CI 0.92–2.25,p= 0.11), length of hospital stay (MD 2.13 days, 95% CI −0.89–5.15,p= 0.17) or OS (adjusted HR 1.48, 95% CI, 0.97–2.28,p= 0.07) between the patients with and without sarcopenia. Sarcopenia increased intraoperative blood loss (MD 388.00 mL, 95% CI, 114.99–683.01,p= 0.006) and the need for blood transfusion (OR 2.27, 95% CI, 1.66, 3.10,p< 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.
目的：本研究旨在明确肌肉减少症对接受肝门部胆管癌根治性切除术患者预后的影响。方法：按照PRISMA标准进行系统综述与荟萃分析，检索比较接受肝门部胆管癌手术的肌肉减少症与非肌肉减少症患者的研究。观察指标包括术后死亡率、Clavien–Dindo≥3级并发症、术中失血量、输血需求、住院时间及总生存期（OS）（时间-事件数据）。采用随机效应模型计算比值比（OR）、均数差（MD）和校正风险比（HR）作为综合效应量，并使用预后研究质量评估工具进行偏倚风险评估。结果：共纳入5项研究，涉及1304例患者。肌肉减少症与非肌肉减少症患者在术后死亡率（OR 1.85，95% CI 0.75–4.57，p=0.18）、Clavien–Dindo≥3级并发症（OR 1.44，95% CI 0.92–2.25，p=0.11）、住院时间（MD 2.13天，95% CI −0.89–5.15，p=0.17）及总生存期（校正HR 1.48，95% CI 0.97–2.28，p=0.07）方面均无显著差异。肌肉减少症患者术中失血量更高（MD 388.00 mL，95% CI 114.99–683.01，p=0.006），且输血需求显著增加（OR 2.27，95% CI 1.66–3.10，p<0.00001）。结论：肌肉减少症可能增加肝门部胆管癌切除术中的出血风险（证据确定性低），但未转化为更高的术后并发症或死亡风险（证据确定性中等）。总生存期的研究结果可能存在Ⅱ类错误，因此肌肉减少症对肝门部胆管癌切除术远期预后的影响尚不明确，需进一步研究。
肿瘤(癌症)患者之家