Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer

Abstract

Objective: To investigate the impact of thoracic body composition on outcomes after lobectomy for lung cancer Summary and Background Data: Preoperative identification of patients at risk for adverse outcomes permits treatment modification. The impact of body composition on lung resection outcomes has not been investigated in a multicenter setting. Methods: A total of 958 consecutive patients undergoing lobectomy for lung cancer at 3 centers from 2014 to 2017 were retrospectively analyzed. Muscle and adipose tissue cross-sectional area at the fifth, eighth, and tenth thoracic vertebral body was quantified. Prospectively collected outcomes from a national database were abstracted to characterize the association between sums of muscle and adipose tissue and hospital length of stay (LOS), number of any postoperative complications, and number of respiratory postoperative complications using multivariate regression. A priori determined covariates were forced expiratory volume in 1 second and diffusion capacity of the lungs for carbon monoxide predicted, age, sex, body mass index, race, surgical approach, smoking status, Zubrod and American Society of Anesthesiologists scores. Results: Mean patient age was 67 years, body mass index 27.4 kg/m 2 and 65% had stage i disease. Sixty-three percent underwent minimally invasive lobectomy. Median LOS was 4 days and 34% of patients experienced complications. Muscle (using 30 cm 2 increments) was an independent predictor of LOS (adjusted coefficient 0.972; P ¼ 0.002), any postoperative complications (odds ratio 0.897; P ¼ 0.007) and postoperative respiratory complications (odds ratio 0.860; P ¼ 0.010). Sarcopenic obesity was also associated with LOS and adverse outcomes. Conclusions: Body composition on preoperative chest computed tomography is an independent predictor of LOS and postoperative complications after lobectomy for lung cancer.

Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

“…Similar to prior studies, pulmonary function tests showed no significant effect 13 . As previously demonstrated, age was not associated with survival, highlighting that mortality risk is not so much defined by chronologic, but morphologic age 16,34–36 …”

“…The choice of analyzed thoracic vertebral levels in this study was informed by prior reports and our own institutional experience 13,16,23 …”

“…Patients were identified using prospectively maintained registries, the institutional sample of the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) at the MGH and the institutional cancer registry at HDB. Three exclusion criteria were applied (Figure 1): Patients without available chest CT scan within 90 days prior to pneumonectomy, 14,15 artifacts precluding assessment of sarcopenia at the T10 thoracic vertebral body, 16 and incomplete clinical data.…”

“…The likelihood‐ratio test was used to assess whether the addition of sarcopenia or muscle improved model fit comparing the full models to restricted models without sarcopenia or muscle. Inter‐software and inter‐analyst agreement were assessed using intraclass correlation coefficients 14,16 . All analyses were performed using STATA (version 13.0, StataCorp).…”

How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery?

“…[ 25 ] In addition, computed tomographic thoracic scans that are performed preoperatively may precisely detect patients with low muscle mass and fatty muscle infiltration which are predictive of mortality, major complications and prolonged hospital stay after colorectal surgery and lung cancer resection. [ 26 27 ]…”