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. 2023 Mar 31;15(3):1063-1074.
doi: 10.21037/jtd-22-1156. Epub 2023 Mar 6.

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass

Seung-Wan Hong  1 , Song-Am Lee  2 , Seong-Hyop Kim  1   3   4
Affiliations

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass

Seung-Wan Hong et al. J Thorac Dis. .

Abstract

Background: This retrospective study was designed to evaluate preoperative pulmonary function test (PFT) results and skeletal muscle mass, represented by the erector spinae muscle (EM), as predictors of postoperative pulmonary complications (PPCs) in older patients undergoing lobectomy for lung cancer.

Methods: The medical records, including preoperative PFT, chest computed tomography (CT) and PPCs, of patients older than 65 years undergoing lobectomy for lung cancer were retrospectively examined at Konkuk University Medical Center from January 2016 to December 2021. The sum of cross-sectional areas (CSAs) of the right and left EMs at the level of the spinous process with the 12th thoracic vertebra was used as the skeletal muscle mass (CSABoth).

Results: Data from a total of 197 patients were included in the analyses. In total, 55 patients had PPCs. The preoperative functional vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) showed significantly poorer values and the CSABoth had significantly lower values in patients with than in those without PPCs. The preoperative FVC and FEV1 showed significant positive correlations with CSABoth. Multiple logistic regression analysis identified age, diabetes mellitus (DM), preoperative FVC and CSABoth as risk factors for PPCs. The areas under the curves for FVC and CSABoth were 0.727 (95% CI, 0.650-0.803; P<0.001) and 0.685 (95% CI, 0.608-0.762; P<0.001), respectively. The optimal threshold values of FVC and CSABoth to predict PPCs based on a receiver operating characteristic curve analysis were 2.685 L (sensitivity =64.1% and specificity =61.8%) and 28.47 mm2 (sensitivity =62.0% and specificity =61.5%), respectively.

Conclusions: PPCs in older patients undergoing lobectomy for lung cancer were associated with lower preoperative FVC and FEV1 values and a lower skeletal muscle mass. Skeletal muscle mass, represented by the EM, was significantly correlated with the preoperative FVC and FEV1. Therefore, skeletal muscle mass may be useful for the prediction of PPCs in patients undergoing lobectomy for lung cancer.

Keywords: Pulmonary function test (PFT); lobectomy; lung cancer; older patient; skeletal muscle mass.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1156/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of patient selection and classification. PPCs, postoperative pulmonary complications.
Figure 2
Figure 2
Measurement of total skeletal muscle mass in the erector spinae muscles at the level of the spinous process with the 12th thoracic vertebra. Erector spinae muscles are represented in green colour.
Figure 3
Figure 3
Correlation between the preoperative pulmonary function test and the CSABoth at the level of the spinous process with the 12th thoracic vertebra. (A) FVC; (B) FEV1. CSABoth, sum of the cross-sectional areas of the right and left erector spinae muscles; FVC, functional vital capacity; FEV1, forced expiratory volume in 1 second.
Figure 4
Figure 4
ROC curve for the prediction of PPCs from age, preoperative FVC and the CSABoth at the level of the spinous process with the 12th thoracic vertebra CSABoth. (A) Age; (B) FVC; (C) CSABoth. ROC, receiver operating characteristic; PPCs, postoperative pulmonary complications; FVC, functional vital capacity; CSABoth, sum of the cross-sectional areas of the right and left erector spinae muscles.
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