Diaphragm Kinetics Following Hepatic Resection

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    RWTH Aachen University
Updated on 24 May 2021
muscle biopsy


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 post-operative pulmonary function.

  • Both major hepatic resection and sarcopenia have a measurable impact on diaphragm function.
  • 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 to non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared to non-sarcopenic patients.

Methods and analysis:

Trans-costal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in patients undergoing major hepatic resection starting one day prior to surgery and up to thirty 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 (SPPB). 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.

Condition Sarcopenia, muscle atrophy, Muscular Atrophy, Diaphragm Kinetics, amyotrophy, muscle wasting, liver resection, Hepatectomy
Treatment Major liver resection, Major liver resection
Clinical Study IdentifierNCT04889235
SponsorRWTH Aachen University
Last Modified on24 May 2021


Yes No Not Sure

Inclusion Criteria

Patients between 18- and 80 years old
Patients undergoing elective Major hepatic resection for the treatment of malignant disease
Patients with all tumor Stages (TNM classification)
Only patients undergoing Major hepatic resection

Exclusion Criteria

American Anesthesiology Association (ASA)-classification IV or higher
Liver cirrhosis Child grade B or higher
End stage renal disease requiring dialysis
Severe heart disease New York Heart Association class IV
Pulmonary condition
Chronic obstructive pulmonary disease (COPD)
History of pulmonary surgery
History of pulmonary embolism
Pleural effusion occupying more than 1/3 of the pleural space
Neurological disorders leading to paraparesis of the upper or lower limbs
Known muscular dystrophic disorders
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