Heterogeneity in CT-Based Skeletal Muscle Mass Assessment and Sarcopenia Diagnosis Undermines Comparability in Hepatopancreatobiliary Surgery: A Scoping Review

Background/Objectives: Sarcopenia has emerged as an important prognostic factor in patients undergoing hepatopancreatobiliary (HPB) surgery. However, substantial heterogeneity in assessment methods and diagnostic thresholds limits comparability across studies. The aim of this review is to systematically characterize methodological variability in sarcopenia assessment within HPB surgical literature, quantify dispersion in reported cut-off values, and highlight key areas requiring standardization.

Methods

A structured search of PubMed, Scopus, and Web of Science was conducted to identify studies evaluating sarcopenia in adult patients undergoing surgery for benign or malignant HPB diseases. The included studies assessed skeletal muscle mass with computed tomography (CT)-based measures, rather than sarcopenia as defined in contemporary consensus definitions. Data were extracted regarding imaging modality, anatomical landmarks, muscle indices, normalization strategies and diagnostic thresholds. Between-study variability in skeletal muscle index (SMI) thresholds was quantified using the coefficient of variation (CV).