08634476

August 30, 2025, 08:39

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Dear Editor, We read with great interest the article “Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes” by Zhang et al. This study provides valuable insights into the association between obstructive jaundice and sarcopenia, as well as the subsequent effects on postoperative outcomes, which fills an important gap in clinical research on hepatobiliary-pancreatic diseases. However, three aspects could be further refined to enhance the depth of evidence and clinical applicability of the findings. First, the study lacks analysis of the impact of preoperative biliary drainage (PBD) on sarcopenia and postoperative outcomes. The article mentions that PBD is recommended for patients with total bilirubin (TBIL) levels exceeding 34-51 μmol/L, yet it does not specify how many patients in the obstructive jaundice group underwent PBD, nor does it explore whether PBD affects sarcopenia-related indicators (such as grip strength, walking speed, and appendicular skeletal muscle index) or modifies the association between jaundice severity and sarcopenia. Clinically, PBD can alleviate cholestasis, improve nutritional absorption, and reduce systemic inflammation—factors that may mitigate muscle loss. Without stratifying outcomes by PBD status, it is difficult to determine whether PBD could serve as an intervention to reduce sarcopenia risk in patients with severe jaundice, which limits the study’s guidance for preoperative management. Second, the correlation between sarcopenia and long-term outcomes (e.g., in-hospital mortality, long-term survival) was not investigated. The current analysis focuses on short-term outcomes such as postoperative hospital stay and complication rates, but it does not mention in-hospital mortality data or follow-up results beyond discharge. Previous studies have shown that sarcopenia is associated with reduced long-term survival in patients undergoing abdominal surgery, such as hepatectomy or pancreaticoduodenectomy. For patients with obstructive jaundice (especially those with malignant etiologies), clarifying whether sarcopenia predicts long-term prognosis would provide more comprehensive evidence for clinical decision-making—for example, guiding the intensity of follow-up or the need for long-term nutritional interventions. The absence of such data weakens the study’s ability to address the full clinical impact of sarcopenia. Third, the study does not explore the potential mediating role of inflammatory or nutritional biomarkers in the relationship between obstructive jaundice and sarcopenia. The discussion hypothesizes that jaundice-induced inflammation (e.g., elevated TNF-α, IL-6) and malnutrition contribute to muscle loss, but the study did not measure these biomarkers (e.g., cytokine levels, vitamin D, or amino acid profiles) or analyze their mediating effects. For instance, if patients with severe jaundice have higher IL-6 levels that are independently associated with sarcopenia, this would support inflammation as a key mechanism linking jaundice to muscle wasting. Without such analyses, the proposed pathophysiological pathway remains speculative, and it is difficult to identify potential targets for interventions (e.g., anti-inflammatory therapies or vitamin D supplementation) to prevent sarcopenia in this population. In conclusion, Zhang et al.’s study makes a meaningful contribution to understanding the prevalence and short-term impact of sarcopenia in patients with obstructive jaundice. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more actionable guidance for preoperative assessment and intervention in this patient group. We look forward to seeing supplementary analyses or follow-up studies to address these points. Sincerely, Xiong Yuezhihong Yichang Central People's Hospital

First, thank you very much for your professional comments on the article published in World Journal of Gastrointestinal Surgery. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastrointestinal Surgery at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.