The relation of body adiposity to the outcomes of thoracoscopic lobectomy for lung cancer – a single-center cohort study

Introduction
The outcomes of lung cancer surgery depend on the patients’ nutritional status. Body fat percentage (BF%) is one of the indicators of body composition and nutritional status. Direct measurement of BF% is complicated, requires significant resources and is rarely performed. The CUN-BAE (Clínica Universidad de Navarra – Body Adiposity Estimator) index has been shown to accurately predict BF% is several clinical settings, but its relation to the outcomes of lung surgery has not been reported so far.

Aim
To determine the relation of the BF% to the outcomes of thoracoscopic lobectomy.

Material and methods
This retrospective study included 1,183 patients who underwent thoracoscopic lobectomy for non-small cell lung cancer between June 1999, and September 2019 at one department. BF% was calculated according to the Clínica Universidad de Navarra – Body Adiposity Estimator equation. The primary endpoints were postoperative complications and long-term survival.

Results
Univariate analysis showed that higher BF% was related to lower incidence of complications (p = 0.001), including prolonged air leak (p < 0.001), atelectasis (p < 0.05), psychosis (p < 0.001), reoperations (p < 0.05), and shorter chest drainage (p = 0.001) and hospitalization duration (p < 0.001). Multivariate analysis showed that higher BF% was correlated with lower risk of complications (p = 0.005; OR = 0.964; 95% CI: 0.940 to 0.989), including prolonged air leak (p < 0.001; OR = 0.923; 95% CI: 0.886 to 0.962), and shorter duration of chest drainage (p < 0.001; B = –0.046; 95% CI: –0.069 to –0.023) and hospitalization (p < 0.001; B = –0.112; 95% CI: –0.176 to –0.048). Cox proportional hazards regression analysis showed that BF% was not related to long-term survival.

Conclusions
Body fat percentage is a valuable tool that can help predict the short-term outcomes of minimally lobectomy for lung cancer.