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Our study aims to assess sarcopenia\u2019s impact, measured by Psoas Muscle Index (PMI), on postoperative outcomes. We retrospectively studied patients aged\u2009\u2265\u200960\u00a0years who underwent LR for HCC between 2014 and 2018. PMI, derived from preoperative CT scans, and Textbook Outcome (TO) for LR were assessed. A nomogram predicting overall survival (OS) was developed via multivariable analysis. Of the 149 eligible HCC patients, the median PMI was 7.225 cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> in males and 4.882 cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> in females, with 37 (24.8%) patients identified as sarcopenic. Mortality was significantly associated with sarcopenia (HR 2.15; <jats:italic>p<\/jats:italic>\u2009=\u20090.032), MELD\u2009\u2265\u200910 (HR 3.13; <jats:italic>p<\/jats:italic>\u2009=\u20090.001),\u2009&gt;\u20093 HCC nodules (HR 4.97; <jats:italic>p<\/jats:italic>\u2009=\u20090.001), and Clavien\u2013Dindo\u2009\u2265\u20093 complications (HR 3.38; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Sarcopenic patients had a 5-year OS of 38.8% compared to 61% for non-sarcopenic individuals (<jats:italic>p<\/jats:italic>\u2009=\u20090.085). Achieving TO correlated with higher OS (<jats:italic>p<\/jats:italic>\u2009=\u20090.01). In sarcopenic cases, the absence of postoperative complications emerged as a limiting factor. Sarcopenic patients failing to achieve TO had worse OS compared to non-sarcopenic and TO-achieving counterparts (5-year OS 18.5%; <jats:italic>p<\/jats:italic>\u2009=\u20090.00039). Sarcopenia emerges as a prognostic factor for LR outcomes in elderly HCC patients. Postoperative complications in sarcopenic patients may compromise oncological outcomes.<\/jats:p>","DOI":"10.1007\/s13304-024-01992-3","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T13:03:02Z","timestamp":1728306182000},"page":"2645-2654","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Textbook outcome and nomogram-guided approaches for enhancing surgical success in elderly HCC patients: Deciphering the influence of sarcopenia"],"prefix":"10.1007","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-7918","authenticated-orcid":false,"given":"Jacopo","family":"Lanari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Lupi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Billato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remo","family":"Alessandris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Crim\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Caregari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Pepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Enrico","family":"D\u2019Amico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Quaia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Gringeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"1992_CR1","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s00268-005-1130-6","volume":"29","author":"H Petrowsky","year":"2005","unstructured":"Petrowsky H, Clavien P-A (2005) Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients? 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This retrospective\u00a0study\u00a0involving human participants was conducted in accordance with the ethical standards of the institutional and national research committee and the Declaration of Helsinki (as revised in 2013). The study was approved by the ethics board of Territorial Ethics Committee Central\u2014Eastern Veneto Area (CET\u2013ACEV)\u2014Regional Resolution No. 330\/2023 (protocol number 448n\/A0\/23, 18 January 2024).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Each patient gave informed consent for every procedure performed and for the use of data for research and publication purposes.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}