209. Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy for Lung Cancer
Maria Lucia L. Madariaga, Fabian M. Troschel, Till Best, Sheila Knoll, Ashok Muniappan, Florian J. Fintelmann, *Henning A. Gaissert
Massachusetts General Hospital, Boston, MA
Invited Discussant: *Katie S. Nason
Objective: Sarcopenia measured by psoas muscle area is associated with increased hospital length of stay (LOS), postoperative complications and mortality. Thoracic skeletal muscle area (TSMA) derived from routine chest computed tomography (CT) is readily available and potentially more relevant for patients undergoing thoracic operations. We studied whether TSMA predicts outcomes after pneumonectomy for lung cancer.
Methods: Consecutive patients from 2005 to 2017 who underwent CT suitable for image analysis within 90 days prior to pneumonectomy for lung cancer were retrospectively analyzed. TSMA was calculated from the area of all muscles on a single CT slice at the 8th thoracic vertebral body. Patients were stratified into TSMA quartiles by gender. Multivariable analysis adjusting for age, gender, body mass index, %FEV1, Zubrod score and type of pneumonectomy was used to assess the effect of TSMA on 90-day postoperative complications, hospital LOS and 90-day hospital readmission.
Results: There were 128 patients who underwent standard (n=103, 80.5%), carinal (n=9, 7%) or completion (n=16, 12.5%) pneumonectomy. Neoadjuvant therapy was administered to 42.2% (n=54) of patients. Major complications occurred in 32.0% (n=41) and readmission within 90 days in 18.8% (n=24) of patients. Mean TSMA was 118.5 cm2 for males and 75.2 cm2 for females. TSMA predicted postoperative complications (OR 2.69, p=0.019) and cardiopulmonary complications (OR 3.09, p=0.009). Patients with TSMA in the lowest quartile had a major postoperative complication at twice the rate of patients with TSMA in the upper quartiles (53.1% vs. 25%). In multivariate models, the lowest quartile TSMA was associated with prolonged ICU LOS (HR 0.61, p=0.045) and hospital LOS (HR 0.61, p=0.046).
Conclusions: TSMA predicts adverse outcome after pneumonectomy for lung cancer. This marker, readily derived from routine chest CT, identifies patients at risk for postoperative complications, including cardiopulmonary complications. Focused preoperative intervention in patients with low TSMA may improve outcomes following pneumonectomy.