Impact Of Sarcopenia On The Development Of Postoperative Complications In Lung Cancer Patients

Objectives:1.To explore how to distinguish sarcopenia from non-sarcopenia using thoracic skeletal muscle index(SMI).2.To investigate the impact of sarcopenia on the incidence of postoperative complications in lung cancer patients.Methods:The clinical data of 126 patients undergoing lung cancer surgery in 2019 were retrospectively analyzed.According to the preoperative thoracic computed tomography(CT)images and general information of lung cancer patients,the cross-sectional area(CSA)of thoracic muscles at the levels of the fourth thoracic vertebra(T4),the fifth thoracic vertebra(T5)and the sixth thoracic vertebra(T6)were measured.SMI at the levels of T4,T5 and T6 were obtained by standardization of height.The cut-off value for sarcopenia was selected using the lowest quartile thoracic SMI after gender grouping.This threshold was used to divide the patients into the sarcopenia group(n=31)and the non-sarcopenia group(n=95),and the incidence of various postoperative complications was compared between the two groups.The influencing factors of postoperative complications were analyzed by univariate analysis,and the independent risk factors of various postoperative complications were investigated by binary logistic regression analysis.Results:1.Age,sex,body mass index(BMI),geriatric nutritional risk index(G NRI),operation ways and sarcopenia were significantly correlated with sever e postoperative complications(P<0.05).Only sarcopenia,which grouped by T4-SMI,T5-SMI or T6-SMI,was an independent risk factor for severe post operative complications in multivariate analysis(Waldχ~2=1.759,P=0.047;Wa ldχ~2=1.889,P=0.029;Waldχ~2=1.934,P=0.035).2.Age,sex,BMI,GNRI,operation ways and sarcopenia were the influencing factors of postoperative pulmonary infection(P<0.05).Only sarcopenia,which grouped by T4-SMI,T5-SMI or T6-SMI,was an independent risk factor for postoperative pulmonary infection in multivariate analysis(Waldχ~2=5.068,P=0.023;Waldχ~2=4.847,P=0.031;Waldχ~2=5.200,P=0.022).3.Sarcopenia was the influencing factor in postoperative acute respiratory distress syndrome(ARDS),postoperative atrial fibrillation(POAF),postoperative gastroparesis,longer chest tube duration and longer hospital stay after operation(P<0.05).However,sarcopenia was not an independent risk factor in multivariate analysis(P<0.05).Conclusions:Sarcopenia,which grouped by T4-SMI,T5-SMI or T6-SMI,was an independent risk factor for severe postoperative complications and postoperative pulmonary infection.Sarcopenia was not a good predictor of POAF,postoperative ARDS,postoperative gastroparesis,longer chest tube duration and longer hospital stay after operation.For lung cancer patients with sarcopenia,Perioperative management should be strengthened to enhance the vigilance for the occurrence of severe postoperative complications and postoperative pulmonary infection.