Mapping Perioperative Vulnerability and Optimization in Hepatectomy: A Bibliometric and Scientometric Analysis of Sarcopenia, Frailty, and Prehabilitation.

PURPOSE: Risk assessment before hepatectomy is no longer based only on tumor burden, liver function, and technical resectability. Muscle status, frailty, nutrition, exercise capacity, and prehabilitation are now discussed more often in this setting. This study reviewed how these topics appear in the hepatectomy literature and how they relate to the more established body composition literature.

METHODS

Relevant publications were retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. CiteSpace (version 6.4.R1), VOSviewer (version 1.6.20), and RStudio (version 2025.05.1 + 513) were used to analyze publication trends, collaboration networks, journal distributions, co-citation structures, keyword co-occurrence, citation bursts, and temporal patterns.

RESULTS

A total of 498 publications were included. Publication output increased during the study period, especially after 2021. Japan, China, and the United States contributed the most papers, whereas several European countries had stronger positions in the collaboration network. Sarcopenia and body composition remained the main basis of this literature. Frailty, functional vulnerability, nutritional support, exercise, and prehabilitation appeared more often in recent years, but collaboration between institutions and author groups was still incomplete.

CONCLUSIONS

Current hepatectomy research in this area is still centered on body composition-based risk assessment. Newer studies have added frailty, functional reserve, nutrition, exercise capacity, and prehabilitation to the same perioperative discussion. Future work should test practical pathways that connect these measures with surgical decision-making, patient selection, and preoperative optimization.