Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study
BMJ Open, vol. 11, pp. e053148
Abstract
INTRODUCTION: Sarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical interventions. Little is known about the function of the diaphragm in the context of sarcopenia and wasting disorders or how its function is influenced by abdominal surgery. Liver surgery induces reactive pleural effusion in most patients, compromising postoperative pulmonary function. We hypothesise that both major hepatic resection and sarcopenia have a measurable impact on diaphragm function. Furthermore, we hypothesise that sarcopenia is associated with reduced preoperative diaphragm function, and that patients with reduced preoperative diaphragm function show a greater decline and reduced recovery of diaphragm function following major hepatic resection. The primary goal of this study is to evaluate whether sarcopenic patients have a reduced diaphragm function prior to major liver resection compared with non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared with non-sarcopenic patients. METHODS AND ANALYSIS: Transcostal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in 33 sarcopenic and 33 non-sarcopenic patients undergoing right-sided hemihepatectomy starting 1 day prior to surgery and up to 30 days after surgery. In addition, rectus abdominis and quadriceps femoris muscles thickness will be measured using ultrasound to measure sarcopenia, and pulmonary function will be measured using a hand-held bedside spirometer. Muscle mass will be determined preoperatively using CT-muscle volumetry of abdominal muscle and adipose tissue at the third lumbar vertebra level (L3). Muscle function will be assessed using handgrip strength and physical condition will be measured with a short physical performance battery . A rectus abdominis muscle biopsy will be taken intraoperatively to measure proteolytic and mitochondrial activity as well as inflammation and redox status. Systemic inflammation and sarcopenia biomarkers will be assessed in serum acquired perioperatively. ETHICS AND DISSEMINATION: This trial is open for recruitment. The protocol was approved by the official Independent Medical Ethical Committee at Uniklinik (Rheinish Westphälische Technische Hochschule (RWTH) Aachen (reference EK309-18) in July 2019. Results will be published via international peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals and patients. TRIAL REGISTRATION NUMBER: ClinicalTrials. gov (EK309-18); Pre-results.
Authors 8
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Gregory van der Kroft corresponding Aachen Department of General, Hepatobiliary and Transplant Surgery
Affiliation as printed
Department of General, Hepatobiliary and Transplant Surgery, Uniklinik RWTH-Aachen, Aachen, Germany gregory.kroft@gmail.com
Department of General, Hepatobiliary and Transplant Surgery, Uniklinik RWTH-Aachen, Aachen, Germany
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Affiliation as printed
Department of Intensive Care Medicine and Intermediate Care, Uniklinik RWTH-Aachen, Aachen, Germany
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Surgery, Maastricht Universitair Medisch Centrum (MUMC+), Maastricht, Netherlands
NUTRIM School of Nutrition and Translational Research In Metabolism, Maastricht University, Maastricht, Netherlands
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Affiliation as printed
Department of General, Hepatobiliary and Transplant Surgery, Uniklinik RWTH-Aachen, Aachen, Germany
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Affiliation as printed
Department of Anaesthesiology, Uniklinik RWTH-Aachen, Aachen, Germany
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Maastricht University Medical Centre · Universitätsklinikum Aachen
Affiliation as printed
Department of General, Hepatobiliary and Transplant Surgery, Uniklinik RWTH-Aachen, Aachen, Germany
Department of Surgery, Maastricht Universitair Medisch Centrum (MUMC+), Maastricht, Netherlands
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Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen
Affiliation as printed
Department of General, Hepatobiliary and Transplant Surgery, Uniklinik RWTH-Aachen, Aachen, Germany
Department of Surgery, Maastricht Universitair Medisch Centrum (MUMC+), Maastricht, Netherlands
NUTRIM School of Nutrition and Translational Research In Metabolism, Maastricht University, Maastricht, Netherlands
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Affiliation as printed
Department of Anaesthesiology, Uniklinik RWTH-Aachen, Aachen, Germany
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