Table 6. Studies describing the association of surgical outcomes with various obesity measures.
| Study | Sample size | Obesity measure | Results | Comments |
|---|---|---|---|---|
| Alifano et al., 2021 (110) | 54,631 | BMI | Overweight (HR =0.84, 95% CI: 0.81–0.87) and obese (HR =0.80, 95% CI: 0.76–0.84) patients had improved OS, whereas underweight (HR =1.51, 95% CI: 1.41–1.63) patients had worse OS | – |
| Best et al., 2022 (102) | 958 | BMI, IMAT, muscle and SAT areas at T5, T8, and T10 levels | Increasing muscle area predicted length of stay (coefficient =0.9, P=0.002) and decreased postoperative complications (OR =0.8, P=0.007) | Fat areas and BMI were not significant predictors of either outcome |
| Choi et al., 2021 (103) | 440 | FVI† and SMI | Adipopenia was associated with reduced 5-year OS (HR =2.2, 95% CI: 1.1–3.8), but not 5-year DFS or postoperative complications | Relationship persisted after adjusting for age, sex, smoking history, surgical procedure, stage, histologic type, BMI, and sarcopenia |
| Fukumoto et al., 2020 (104) | 16,509 | BMI | Compared to normal BMI group, worse OS in the underweight group (HR =1.41, 95% CI: 1.27–1.57) and better OS in the overweight group (HR =0.88, 95% CI: 0.8–0.96) | BMI was not predictive of postoperative morbidity and mortality |
| Guerrera et al., 2022 (108) | 4,412 | BMI | BMI ≥40 kg/m2 was associated with increased postoperative morbidity only (OR =2.74, 95% CI: 1.63–4.61) | No increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration |
| Icard et al., 2020 (111) | 304 | BMI, muscle mass, weight change | Increased pre-disease BMI (RR =0.66, 95% CI: 0.49–0.89) and pre-surgery BMI (RR =0.72, 95% CI: 0.54–0.98) independently predicted higher OS | – |
| Li et al., 2019 (105) | 1,091 | FFM | Low FFM was predictive of prolonged air leak complicating VATS lobectomy (OR =1.98, 95% CI: 1.33–2.96) | BMI was not predictive |
| Matsuoka et al., 2018 (113) | 158 | BMI | Low (<18.5 kg/m2) and high (≥25 kg/m2) BMI groups had poor OS (HR =1.68, 95% CI: 1.03–2.72) compared to normal BMI group | – |
| Nicastri et al., 2022 (109) | 433 | BMI | Overweight (OR =4, 95% CI: 1.6–11.2) and obese (OR =6.1, 95% CI: 2.4–17.5) patients had increased risk of postoperative home oxygen use after lung resection | – |
| Patnaik et al., 2021 (91) | 613 | BMI | Statin use associated with improved RFS (HR =0.46, P=0.002) in patients with a high BMI only | Tumor transcriptome profiling using RNA sequencing showed higher expression of tumoricidal genes with statin use in high BMI patients |
| Rizzo et al., 2022 (114) | 107 | SAT, SMA, SMD | Decreased SMA (OR =0.8, 95% CI: 0.66–0.96) was associated with increased postpneumonectomy complications in men only | – |
| Shinohara et al., 2020 (115) | 349 | Pericardial fat | Low pericardial fat volume associated with poor OS (HR =2.14, 95% CI: 1.21–3.79) | Pericardial fat volume has linear relationship with BMI |
| Takada et al., 2019 (112) | 546 | BMI | Underweight BMI associated with poor DFS (HR =1.71, 95% CI: 1.1–2.55) and OS (HR =1.97, 95% CI: 1.16–3.19) | – |
| Tong et al., 2022 (107) | 4,035 | BMI | 1:1 propensity score matching showed no difference in rates of perioperative outcomes between obese and non-obese patients | – |
| Wang et al., 2018 (106) | 1,198 | BMI | Underweight patients have increased post-operative mortality (OR =4.39, 95% CI: 1.31–14.72) and respiratory complications (OR =2.88, 95% CI: 1.27–6.50) | Obesity and overweight did not increase surgical complications or length of stay |
| Yuan et al., 2022 (116) | 115,393 | BMI, metabolic score‡ | Metabolically unhealthy normal (HR =1.10), metabolically unhealthy overweight (HR =1.28), and metabolically healthy overweight (HR =1.15) men had a higher risk of readmission than metabolically healthy normal weight men | Similar results were seen in women |
†, FVI (cm3/m2) is the total fat volume (cm3) standardized to the square of the patient height (m); ‡, metabolic score is derived from mid blood pressure, glucose, and triglycerides. BMI, body mass index; HR, hazard ratio; CI, confidence interval; OS, overall survival; IMAT, intramuscular adipose tissue; SAT, subcutaneous adipose tissue; OR, odds ratio; FVI, fat volume index; SMI, skeletal muscle index; DFS, disease free survival; RR, relative risk; FFM, fat free mass; VATS, video-assisted thoracic surgery; RFS, recurrence free survival; SMA, skeletal muscle area; SMD, skeletal muscle density.