Sarcopenia as independent risk factor of postpneumonectomy respiratory failure, ARDS and mortality. (November 2020)

• Record Type: Journal Article
• Authors: Martini, Katharina; Chassagnon, Guillaume; Fournel, Ludovic; Prieto, Mathilde; Hoang-Thi, Trieu-Nghi; Halm, Nara; Bobbio, Antonio; Revel, Marie-Pierre; Alifano, Marco
• Is Part Of: Lung cancer. Volume 149(2020)
• Page Start: 130
• Page End: 136
• Publication Date: 2020-11
• Subjects: ADK Adenocarcinoma -- ARDS Acute respiratory distress syndrome -- ARF Acute respiratory failure -- CCI Charlson Comorbidity Index -- COPD Chronic obstructive pulmonary disease -- CT Computed tomography -- FEV1 Forced expiratory volume -- FVC Forced Vital Capacity -- MV Mechanic ventilation -- PPO FEV1 Predictive post-operative FEV1 -- TMA Total muscle area -- TPA Total psoas area -- TPMA Total parietal muscle area -- SCC Squamous cell carcinoma -- SD Standard deviation -- SMI Skeletal muscle index; Sarcopenia -- Pneumonectomy -- Lung neoplasms -- Survival; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.09.009
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Sarcopenia is associated with short-term outcome in pneumonectomy. Similarly, right side of pneumonectomy was associated with short-term outcome. Muscle surface measurements after fat-suppression are the most distinctive factor. Abstract: Objectives: Sarcopenia is associated with poor outcome in cancer-patients. However, the methods to define sarcopenia are not entirely standardized. We compared several morphometric measurements of sarcopenia and their prognostic value in short-term-outcome prediction after pneumonectomy. Material and Methods: Consecutive lung-cancer patients undergoing pneumonectomy from January 2007 to December 2015 and having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by the following CT-based parameters measured at the level of the third lumbar vertebra: cross-sectional Total Psoas Area (TPA), cross-sectional Total Muscle Area (TMA), and Total Parietal Muscle Area (TPMA), defined as TMA without TPA. Measures were obtained for entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of 33rd percentile was set to define sarcopenia. Acute Respiratory Failure (ARF), Acute Respiratory Distress Syndrome (ARDS), and 30-day mortality were assessed as parameters of short-term-outcome. Results: Two hundred thirty-four patients with pneumonectomy (right, n = 107; left, n = 127) were analysed. Postoperative mortality rate was 9.0 % (21/234), 17.1 % of patients (40/234) experienced ARF requiring re-intubation, and 10.3 % (24/234) had ARDS. All parameters describing sarcopenia gave significant results; the best discriminating parameter was TMA after excluding fat (p < 0.001). While right sided pneumonectomy and sarcopenia were independently associated to the three short-term outcome parameters, Charlson Comorbidity Index only independently predicted ARF. Conclusions: Sarcopenia defined as the sex-related 33rd percentile of fat-excluded TMA at the level of the third lumbar vertebra is the most discriminating parameter to assess short-term-outcome in patients undergoing pneumonectomy.