Computed tomography-defined sarcopenia is associated with failure to achieve textbook outcome after simultaneous colorectal liver metastasis resection

doi:10.4251/wjgo.125399

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Dec 15, 2026; 18(12): 125399
Published online Dec 15, 2026. doi: 10.4251/wjgo.125399

Computed tomography-defined sarcopenia is associated with failure to achieve textbook outcome after simultaneous colorectal liver metastasis resection

Can Zhang, Long Chen, Hua-Chuan Song, Fan-Zheng Meng, Shen-Yu Zhang, Ze-Yang An, Xing-Chun Zhu, Ji-Zhou Wang, Rui-Peng Song

Can Zhang, Rui-Peng Song, Graduate School, Bengbu Medical University, Bengbu 233030, Anhui Province, China

Can Zhang, Long Chen, Hua-Chuan Song, Fan-Zheng Meng, Shen-Yu Zhang, Ze-Yang An, Xing-Chun Zhu, Ji-Zhou Wang, Rui-Peng Song, Department of Hepatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China

Co-first authors: Can Zhang and Long Chen.

Co-corresponding authors: Ji-Zhou Wang and Rui-Peng Song.

Author contributions: Zhang C and Chen L designed the study, performed the statistical analyses, drafted the manuscript, and contributed equally to this work as co-first authors; Song HC, Meng FZ, Zhang SY, An ZY, and Zhu XC collected the clinical data and coordinated patient follow-up; Wang JZ and Song RP conceived and supervised the study, provided administrative support, and critically revised the manuscript for important intellectual content as co-corresponding authors; all authors read and approved the final manuscript.

AI contribution statement: Portions of this manuscript were edited using OpenAI ChatGPT (GPT-5) solely for limited English-language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Supported by the National Natural Science Foundation of China, No. 82272700; the Natural Science Foundation of Anhui Province, No. 2108085MH288; the Youth Innovation Key Fund Project of the University of Science and Technology of China, No. YD9100002003; and the Clinical and Translational Research Project of Anhui Province, No. 202527c10020129.

Institutional review board statement: The Medical Research Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China approved this retrospective study encompassing both participating institutions (approval No. 2024-RE-384).

Informed consent statement: The Medical Research Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China waived the requirement for informed consent for this retrospective study encompassing both participating institutions (approval No. 2024-RE-384).

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: R code, a description of the landmark cohort derivation, and detailed aggregate statistical outputs are supplied with this revision. De-identified analysis data are available from the corresponding author upon reasonable request and subject to institutional and ethical approval.

Corresponding author: Rui-Peng Song, MD, Graduate School, Bengbu Medical University, No. 2600 Donghai Road, Longzihu District, Bengbu 233030, Anhui Province, China. songruipeng@ustc.edu.cn

Received: July 6, 2026
Revised: August 16, 2026
Accepted: October 20, 2026
Published online: December 15, 2026
Processing time: 126 Days and 20.8 Hours

Abstract

BACKGROUND

Simultaneous resection for colorectal liver metastases may shorten the treatment pathway and avoid a second operation. However, it concentrates the physiological demands of colorectal surgery and hepatectomy within a single postoperative recovery period. This combined surgical burden calls for an integrated endpoint that captures overall perioperative recovery rather than a single adverse event. Textbook outcome (TO) is an all-or-none composite measure encompassing mortality, resection margin status, readmission, prolonged hospitalization, and major complications. Whether preoperative computed tomography-defined sarcopenia identifies patients at increased risk of failing to achieve TO after simultaneous resection remains unclear.

AIM

To evaluate associations of preoperative computed tomography (CT)-defined sarcopenia with non-TO and explore postoperative TO-survival associations by sarcopenia status.

METHODS

This multicenter retrospective cohort included 112 patients undergoing simultaneous colorectal and liver resection. Sarcopenia was defined by sex-specific skeletal muscle index cut-offs at the third lumbar vertebra on preoperative CT. TO required no 90-day mortality, R1/R2 resection, unplanned 90-day readmission, hospital stay > 15 days, or Clavien-Dindo grade ≥ III complications. A clinically specified preoperative logistic model evaluated non-TO, with Firth, perioperative, and center-adjusted sensitivity analyses. Exploratory TO-survival analyses used postoperative day 90 as the landmark.

RESULTS

CT-defined sarcopenia was present in 55 of 112 patients (49.1%). TO was achieved in 77.2% of non-sarcopenic and 49.1% of sarcopenic patients (P = 0.003), an absolute difference of 28.1 percentage points (95%CI: 11.0-45.2). In the primary model, sarcopenia (adjusted odds ratio = 3.74, 95%CI: 1.41-9.97; P = 0.008) and maximum tumor diameter ≥ 5 cm (adjusted odds ratio = 9.96, 95%CI: 2.41-41.08; P = 0.001) were associated with non-TO. In day-90 landmark analyses TO was not significantly associated with subsequent overall survival (hazard ratio = 0.66, 95%CI: 0.37-1.18; n = 110) or recurrence-free survival (hazard ratio = 0.78, 95%CI: 0.47-1.29; n = 89). Formal TO × sarcopenia interactions were not statistically significant.

CONCLUSION

Preoperative CT-defined sarcopenia was associated with non-TO after simultaneous colorectal liver metastases resection. Given the retrospective design and modest cohort, prospective validation is required; landmark analyses did not establish robust TO-survival associations.

Keywords: Colorectal liver metastases; Textbook outcome; Sarcopenia; Simultaneous resection; Body composition; Retrospective cohort study

Core Tip: This multicenter cohort of 112 patients undergoing simultaneous resection for colorectal liver metastases found that computed tomography-defined sarcopenia remained associated with failure to achieve textbook outcome (TO) after multivariable adjustment. Descriptive component distributions were consistent with a greater burden of failed recovery criteria. Because TO is determined during the first 90 postoperative days, survival comparisons were reassessed using postoperative day 90 as the landmark and remained exploratory; no robust TO-survival association or interaction by sarcopenia status was established.