Dataset Information

Long-term changes in psoas muscle mass after lobectomy and segmentectomy for early-stage lung cancer.

ABSTRACT:

Background

Segmentectomy is considered a less invasive procedure than lobectomy for patients with non-small cell lung cancer (NSCLC); however, little is known about the physiological mechanism underlying the lower invasiveness of segmentectomy. This study is aimed to compare the differences in the long-term changes in the psoas muscle mass after segmentectomy and lobectomy in patients with NSCLC.

Methods

Overall 315 recurrence-free patients who underwent segmentectomy (n = 93) or lobectomy (n = 222) for clinical stage 0-I NSCLC between January 2016 and December 2018 and underwent computed tomography during the entire period of 6 months ≤ postoperative year (POY) 0.5 < 12 months, 12 months ≤ POY 1 < 24 months, 24 months ≤ POY 2 < 36 months, and 36 months ≤ POY 3 < 48 months were included. Bilateral psoas muscle area (PMA) at the L3 level was measured using each cross-sectional computed tomography scan. Differences between the segmentectomy and lobectomy groups in the mean change of postoperative PMA from the preoperative period were analysed using Student's t-test and mixed analysis of variance. Multivariable analysis was performed to identify the risk factors for PMA loss on POY 3 using logistic regression analysis.

Results

The lobectomy group had a significantly larger PMA change than the segmentectomy group during each postoperative period (P < 0.001). Mixed analysis of variance revealed that the mean PMA change was significantly smaller in the segmentectomy group than in the lobectomy group during the observation period (P < 0.001). The mean change in the PMA was significantly larger from POY1 (-2.5%) to POY2 (-3.9%) and POY3 (-4.7%) in the lobectomy group (P = 0.003 and P < 0.001). However, PMA remained unchanged during the postoperative observation period in the segmentectomy group. In the multivariable analysis, the risk factors for PMA change ≤-3.3% (cut-off: mean change of PMA) at POY3 included lobectomy [odds ratio (OR), 3.32; 95% confidence interval (CI), 1.90-5.82; P < 0.001], male sex (OR, 1.92; 95% CI, 1.02-3.62; P = 0.044) and open thoracotomy (OR, 1.84; 95% CI, 1.11-3.05; P = 0.017). After propensity score matching, the mean change in PMA was smaller in the segmentectomy group (n = 75) than in the lobectomy group (n = 75) during the postoperative observation period (P < 0.001).

Conclusions

Psoas muscle mass was better maintained during the postoperative period by segmentectomy than by lobectomy. Psoas muscle mass reduction progressed over a long postoperative period after lobectomy. Segmentectomy via complete video-assisted thoracic surgery is associated with a lower likelihood of sarcopenia progression.

SUBMITTER: Isaka T

PROVIDER: S-EPMC10751413 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Long-term changes in psoas muscle mass after lobectomy and segmentectomy for early-stage lung cancer.

Isaka Tetsuya T Ito Hiroyuki H Yokose Tomoyuki T Saito Haruhiro H Narimatsu Hiroto H Adachi Hiroyuki H Miura Jun J Murakami Kotaro K Kikunishi Noritake N Shigeta Naoko N Rino Yasushi Y

Journal of cachexia, sarcopenia and muscle 20230923 6

<h4>Background</h4>Segmentectomy is considered a less invasive procedure than lobectomy for patients with non-small cell lung cancer (NSCLC); however, little is known about the physiological mechanism underlying the lower invasiveness of segmentectomy. This study is aimed to compare the differences in the long-term changes in the psoas muscle mass after segmentectomy and lobectomy in patients with NSCLC.<h4>Methods</h4>Overall 315 recurrence-free patients who underwent segmentectomy (n = 93) or ...[more]

PMID: 37740651

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Project description:BackgroundThe impact of lobectomy versus segmentectomy on body composition changes, particularly adipose tissue, in patients with early-stage lung cancer remains unclear. This study aimed to determine the association between these surgical approaches and postoperative changes in adipose tissue.MethodsWe retrospectively analysed visceral fat area (VFA) and waist circumference (WC) at the L3 level using cross-sectional computed tomography images from 346 recurrence-free patients who underwent lobectomy (n = 240) or segmentectomy (n = 106) for clinical stage 0-I primary lung cancer between January 2016 and December 2018. Long-term postoperative changes in VFA and WC by the third postoperative year (POY3) were compared between the lobectomy and segmentectomy groups using two-way repeated measures analysis of variance (ANOVA). Risk factors for VFA reduction were identified through multivariable analysis using logistic regression model. Propensity score matching (PSM, 1:1 matching) was also performed to compare VFA and WC changes between the lobectomy and segmentectomy groups.ResultsAt 6 months postoperatively, VFA and WC decreased by 16.4% and 1.0% in the lobectomy groups, respectively, and increased by 0.1% and 0.2% in the segmentectomy groups (p < 0.001 and p = 0.029, respectively). The two-way repeated measure ANOVA showed that the VFA and WC significantly decreased in the lobectomy group compared with the segmentectomy group within the POY3 (p < 0.001 and p = 0.038, respectively). Patients with a VFA change of ≥ -13% at POY3 (n = 238) had significantly better OS than those with a change of < -13% (n = 108) (5-year OS rate, 97.7% vs. 93.4%, p = 0.017), and VFA change < -13% at POY3 was an independent poor prognostic factor for OS (hazard ratio, 4.14; p = 0.013). Lobectomy was identified as an independent risk factor for a VFA change of < -13% at POY3 (odds ratio, 2.86; p < 0.001). After PSM (n = 93 for each group), VFA and WC significantly decreased in the lobectomy group compared with the lobectomy group within the POY3 (p = 0.009 and p = 0.020, respectively).ConclusionsIn patients with early-stage lung cancer without recurrence, long-term postoperative changes in VFA and WC differed between lobectomy and segmentectomy. Lobectomy resulted in a greater decrease in VFA from 6 months to 3 years postoperatively. In contrast, segmentectomy was associated with neither long-term postoperative VFA nor WC reduction.

Project description:BackgroundRobotic anatomic segmentectomy (RATS) for early-stage lung cancer is being increasingly performed in spite of limited published evidence. To evaluate its safety and oncologic efficacy, we compared the outcomes of both RATS and video-assisted thoracoscopic (VATS) segmentectomy in patients with small-sized (<2 cm) peripheral stage IA lung cancer.MethodsFrom November 2011 to January 2018, a total of 130 patients with resected stage IA non-small cell lung cancer (NSCLC) who underwent RATS (n=50) and VATS (n=80) pulmonary segmentectomy were included. Clinicopathologic data, recurrence rate, and survival were recorded.ResultsThe demographics, pulmonary function, comorbidity, and tumor size were similar between RATS segmentectomy and VATS segmentectomy. The surgery time, intensive care unit stay, hospital stay, and blood loss were reduced in the RATS group compared to the VATS group. The number of totally dissected lymph nodes and postoperative complications were similar between the 2 groups. There was no operative mortality. The intensity of narcotic use during hospital stay and the time to return to routine daily activities were also reduced in the RATS group. There was no recurrence observed in the RATS group during the median 38-month follow-up period; meanwhile, during a median 85-month follow-up period in the VATS group, local recurrence and distant recurrence was observed in 2 patients (2.5%) and 3 patients (3.75%) respectively. There was no significant difference in the 5-year recurrence-free survival between the RATS and VATS groups (100% vs. 93.75%; P>0.05).ConclusionsRATS can be performed safely and effectively in patients with early-stage NSCLC. The reduced narcotic use and earlier return to routine daily activities of RATS patients might reflect its less traumatic nature as compared to VATS. For stage IA disease with small tumors (<2 cm), segmentectomy performed by RATS has better oncologic efficacy when compared to VATS, although in this study, this difference did not reach statistical difference.

Project description:ObjectivesRadiation segmentectomy using yttrium-90 plays an emerging role in the management of early-stage HCC. However, the value of early post-treatment MRI for response assessment is uncertain. We assessed the value of response criteria obtained early after radiation segmentectomy in predicting long-term response in patients with HCC.Materials and methodsPatients with HCC who underwent contrast-enhanced MRI before, early, and 12 months after radiation segmentectomy were included in this retrospective single-center study. Three independent radiologists reviewed images at baseline and 1st follow-up after radiation segmentectomy and assessed lesion-based response according to mRECIST, LI-RADS treatment response algorithm (TRA), and image subtraction. The endpoint was response at 12 months based on consensus readout of two separate radiologists. Diagnostic accuracy for predicting complete response (CR) at 12 months based on the 1st post-treatment MRI was calculated.ResultsEighty patients (M/F 60/20, mean age 67.7 years) with 80 HCCs were assessed (median size baseline, 1.8 cm [IQR, 1.4-2.9 cm]). At 12 months, 74 patients were classified as CR (92.5%), 5 as partial response (6.3%), and 1 as progressive disease (1.2%). Diagnostic accuracy for predicting CR was fair to good for all readers with excellent positive predictive value (PPV): mRECIST (range between 3 readers, accuracy: 0.763-0.825, PPV: 0.966-1), LI-RADS TRA (accuracy: 0.700-0.825, PPV: 0.983-1), and subtraction (accuracy: 0.775-0.825, PPV: 0.967-1), with no difference in accuracy between criteria (p range 0.053 to > 0.9).ConclusionmRECIST, LI-RADS TRA, and subtraction obtained on early post-treatment MRI show similar performance for predicting long-term response in patients with HCC treated with radiation segmentectomy.Clinical relevance statementResponse assessment extracted from early post-treatment MRI after radiation segmentectomy predicts complete response in patients with HCC with high PPV (≥ 0.96).Key points• Early post-treatment response assessment on MRI predicts response in patients with HCC treated with radiation segmentectomy with fair to good accuracy and excellent positive predictive value. • There was no difference in diagnostic accuracy between mRECIST, LI-RADS, and subtraction for predicting HCC response to radiation segmentectomy.

Dataset Information

Long-term changes in psoas muscle mass after lobectomy and segmentectomy for early-stage lung cancer.

Background

Methods

Results

Conclusions

Publications

Long-term changes in psoas muscle mass after lobectomy and segmentectomy for early-stage lung cancer.

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