Supplementary Material for: Preoperative Low Muscle Mass and Low Muscle Quality Negatively Impact on Pulmonary Function in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

<p><b><i>Background:</i></b> Sarcopenia is a prognostic factor for mortality in digestive surgery. However, the correlation between preoperative cardiopulmonary function and sarcopenia in patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains unclear. <b><i>Methods:</i></b> The present study investigated the impact of preoperative sarcopenia on cardiopulmonary function in 402 patients who underwent first hepatectomy for HCC between April 2005 and April 2015. The quantity and quality of skeletal muscle were evaluated using psoas muscle index (PMI) and intramuscular adipose tissue content (IMAC), respectively, as determined from preoperative computed tomography imaging. Correlations between preoperative cardiopulmonary function and sarcopenic factors (PMI and IMAC) were evaluated. <b><i>Results:</i></b> No significant correlations were found between left ventricular ejection fraction and the two sarcopenic factors. On the other hand, preoperative vital capacity (VC) and forced expiratory volume in 1 s (FEV<sub>1</sub>) correlated significantly with PMI (<i>p</i> < 0.001 each) in males and with IMAC (<i>p</i> < 0.001 each) in females. Moreover, VC and FEV<sub>1</sub> in the preoperative low PMI (<i>p</i> < 0.001 each) and high IMAC (<i>p</i> = 0.002 and <i>p</i> < 0.001, respectively) groups were significantly lower than in the normal group in males. In females, VC and FEV<sub>1</sub> were significantly lower in the preoperative high IMAC group than in the normal group (<i>p</i> < 0.001 each). <b><i>Conclusion:</i></b> Preoperative low muscle mass in males and low muscle quality in males and females were significantly associated with pulmonary dysfunction.</p>