Subscribe to RSS
DOI: 10.1055/s-0035-1554964
Body Mass Index as a Prognostic Factor in Resected Lung Cancer: Obesity or Underweight, Which Is the Risk Factor?
Publication History
21 February 2015
06 May 2015
Publication Date:
16 August 2015 (online)
![](https://www.thieme-connect.de/media/thoracic/201507/lookinside/thumbnails/10-1055-s-0035-1554964_154046ot-1.jpg)
Abstract
Background In general, obesity is thought to be associated with increased surgical mortality and morbidity. On the other hand, low body mass index (BMI) has recently been reported as a poor prognostic factor for surgical candidates. This study investigated the effect of BMI on lung surgery.
Methods A retrospective study was conducted on 1,518 consecutive patients who had malignant pulmonary tumors resected between February 2008 and March 2013. BMI was used to classify patients according to the World Health Organization definition: BMI < 18.5: underweight (UW); BMI 18.5 to <25: normal weight (NW); BMI 25 to <30: overweight (OW); and BMI ≥ 30: obese (OB). We defined surgical resection-related mortality as any patient who died within 90 days after resection or while in the hospital. We analyzed morbidity and surgical resection-related mortality, and logistic regression analysis was used to identify predictors for surgical resection-related mortality.
Results Among the four groups, the incidence of cerebrovascular complications was 1.5% in UW, 0.4% in NW, 0% in OW, and 0% in OB, and that of pulmonary complications was 13.1% in UW, 8.4% in NW, 7.3% in OW, and 7.6% in OB. Surgical resection-related mortality was 2.9% in UW, 0.6% in NW, 1.7% in OW, and 0% in OB. Multivariate analysis revealed underweight, diffusing capacity of the lung for carbon monoxide, and male sex as the significant predictors.
Conclusions In this study, low BMI was an independent risk factor for mortality, and the incidence of cerebrovascular and pulmonary complications tended to be higher in patients with low BMI than in obese patients. Underweight patients should be closely monitored following pulmonary resection.
Note
This manuscript was presented at the 22nd European Conference on General Thoracic Surgery, which was referred to Interact Cardiovasc Thorac Surg (2014);18(Suppl 1):S20–S21. doi: 10.1093/icvts/ivu167.78 1.
-
References
- 1 Fasol R, Schindler M, Schumacher B , et al. The influence of obesity on perioperative morbidity: retrospective study of 502 aortocoronary bypass operations. Thorac Cardiovasc Surg 1992; 40 (3) 126-129
- 2 Holley JL, Shapiro R, Lopatin WB, Tzakis AG, Hakala TR, Starzl TE. Obesity as a risk factor following cadaveric renal transplantation. Transplantation 1990; 49 (2) 387-389
- 3 Lee CT, Dunn RL, Chen BT, Joshi DP, Sheffield J, Montie JE. Impact of body mass index on radical cystectomy. J Urol 2004; 172 (4 Pt 1) 1281-1285
- 4 Mullen JT, Davenport DL, Hutter MM , et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008; 15 (8) 2164-2172
- 5 Klasen J, Junger A, Hartmann B , et al. Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery. Obes Surg 2004; 14 (2) 275-281
- 6 Dhakal B, Eastwood D, Sukumaran S , et al. Morbidities of lung cancer surgery in obese patients. J Thorac Cardiovasc Surg 2013; 146 (2) 379-384
- 7 Falcoz PE, Conti M, Brouchet L , et al. The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg 2007; 133 (2) 325-332
- 8 Launer H, Nguyen DV, Cooke DT. National perioperative outcomes of pulmonary lobectomy for cancer in the obese patient: a propensity score matched analysis. J Thorac Cardiovasc Surg 2013; 145 (5) 1312-1318
- 9 Smith PW, Wang H, Gazoni LM, Shen KR, Daniel TM, Jones DR. Obesity does not increase complications after anatomic resection for non-small cell lung cancer. Ann Thorac Surg 2007; 84 (4) 1098-1105 , discussion 1105–1106
- 10 Attaran S, McShane J, Whittle I, Poullis M, Shackcloth M. A propensity-matched comparison of survival after lung resection in patients with a high versus low body mass index. Eur J Cardiothorac Surg 2012; 42 (4) 653-658
- 11 Bernard A, Rivera C, Pages PB, Falcoz PE, Vicaut E, Dahan M. Risk model of in-hospital mortality after pulmonary resection for cancer: a national database of the French Society of Thoracic and Cardiovascular Surgery (Epithor). J Thorac Cardiovasc Surg 2011; 141 (2) 449-458
- 12 Thomas PA, Berbis J, Falcoz PE , et al; EPITHOR Group. National perioperative outcomes of pulmonary lobectomy for cancer: the influence of nutritional status. Eur J Cardiothorac Surg 2014; 45 (4) 652-659 , discussion 659
- 13 Petrella F, Radice D, Borri A , et al. The impact of preoperative body mass index on respiratory complications after pneumonectomy for non-small-cell lung cancer. Results from a series of 154 consecutive standard pneumonectomies. Eur J Cardiothorac Surg 2011; 39 (5) 738-744
- 14 St Julien JB, Aldrich MC, Sheng S , et al. Obesity increases operating room time for lobectomy in the society of thoracic surgeons database. Ann Thorac Surg 2012; 94 (6) 1841-1847
- 15 Rabe KF. Treating COPD—the TORCH trial, P values, and the Dodo. N Engl J Med 2007; 356 (8) 851-854
- 16 Ohtaka K, Hida Y, Kaga K , et al. Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann Thorac Surg 2013; 95 (6) 1924-1928
- 17 Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Recent results of postoperative mortality for surgical resections in lung cancer. Ann Thorac Surg 2004; 78 (3) 999-1002 , discussion 1002–1003
- 18 Kozower BD, Sheng S, O'Brien SM , et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg 2010; 90 (3) 875-881 , discussion 881–883
- 19 McMillan RR, Berger A, Sima CS , et al. Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies. Ann Thorac Surg 2014; 98 (5) 1769-1774 , discussion 1774–1775
- 20 Pezzi CM, Mallin K, Mendez AS, Greer Gay E, Putnam Jr JB. Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality. J Thorac Cardiovasc Surg 2014; 148 (5) 2269-2277
- 21 Fiorelli A, Vicidomini G, Mazzella A , et al. The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection. Thorac Cardiovasc Surg 2014; 62 (7) 578-587
- 22 Ferguson MK, Im HK, Watson S, Johnson E, Wigfield CH, Vigneswaran WT. Association of body mass index and outcomes after major lung resection. Eur J Cardiothorac Surg 2014; 45 (4) e94-e99 , discussion e99
- 23 Bagan P, Berna P, De Dominicis F , et al. Nutritional status and postoperative outcome after pneumonectomy for lung cancer. Ann Thorac Surg 2013; 95 (2) 392-396