Comparison of the Changes in Visceral Adipose Tissue After Lobectomy and Segmentectomy for Patients With Early-Stage Lung Cancer

Background: The 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. Methods: We 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. Results: At 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). Conclusions: In 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.