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Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy For Lung Cancer.

M. Madariaga, Fabian M Troschel Cand Med, Till D Best Cand Med, Sheila J Knoll, H. Gaissert, F. Fintelmann
Published 2019 · Medicine

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BACKGROUND Sarcopenia represented by low psoas muscle area is associated with increased hospital length of stay (LOS), postoperative complications and mortality. We studied whether thoracic skeletal muscle area (TSMA) derived from computed tomography (CT) predicts morbidity after pneumonectomy for lung cancer. METHODS Consecutive patients who underwent pneumonectomy for lung cancer from 2005 to 2017 were retrospectively analyzed. TSMA was defined as the sum of muscle area at the level of the 8th and the 12th thoracic vertebral bodies on preoperative CT. Patients were stratified into sex-specific TSMA quartiles for univariate time-to-event analyses. The effect of continuous TSMA measurements on operative complications, hospital and ICU LOS, discharge disposition and hospital readmission within 90 days was estimated using multivariable models adjusted for age, sex, BMI, %FEV1, Zubrod score and pneumonectomy type RESULTS: Standard (n=102, 78.5%) or high-risk pneumonectomy (n=28, 21.5%: extra-pleural (n=3, 2.3%), carinal (n=9, 6.9%), completion (n=16, 12.3%)) was performed in 130 patients (60.8±10.6 years; 43.1% female). Major complications occurred in 33.1% (43/130) and readmission in 17.7% (23/130) of patients. In multivariable models, patients with high TSMA experienced fewer overall (OR 0.87, p=0.04) and cardiopulmonary (OR 0.86, p=0.04) complications, and fewer readmissions (OR 0.78, p=0.01). Associations with ICU LOS (HR 1.08, p=0.051) and hospital LOS (HR 1.05, p=0.18) did not reach significance. CONCLUSIONS TSMA predicts adverse outcome after pneumonectomy for lung cancer. This marker, readily derived from standard chest CT, identifies patients at increased risk for postoperative complications and may help select patients appropriate for focused rehabilitation prior to pneumonectomy.
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