Preprint · Jan 2026
The role of sarcopenia in postoperative outcomes following major hepatopancreatobiliary surgery
By Papakonstantinou M, Tsokkou S, Chatzikomnitsa V
Major hepatopancreatobiliary (HPB) surgery is associated with high metabolic demand, catabolism, and complex perioperative care, rendering preoperative nutritional and functional status particularly relevant. Despite growing interest, prospective data on the impact of sarcopenia in HPB surgery remain scarce, and no consensus exists on optimal screening or confirmatory strategies in this population. This protocol describes a combined prospective-retrospective observational study designed to assess the association between preoperative sarcopenia and postoperative complications in patients undergoing major HPB surgery. Adult patients scheduled for elective major liver, biliary, or pancreatic resection at the First University Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece, will be eligible. Sarcopenia will be screened with the SARC-F questionnaire and hand-grip dynamometry, and confirmed by CT-derived skeletal muscle index (SMI) at the L3 vertebral level. Patients will be grouped as sarcopenic (study group) or non-sarcopenic (control group). The primary outcome is the occurrence of major postoperative complications (Clavien-Dindo grade >III). Secondary outcomes include length of hospital stay, ICU admission, overall survival, disease-free survival, disease recurrence, and postoperative quality of life assessed with the SF-36 (benign conditions) or QLQ-C30 (malignant conditions) questionnaires.