ObjectiveTo evaluate the impact of preoperative respiratory sarcopenia (RS) on postoperative outcomes in patients with non-small cell lung cancer (NSCLC). MethodsA retrospective cohort study was conducted involving NSCLC patients who underwent surgery in the Department of Thoracic Surgery at the First Affiliated Hospital of the University of Science and Technology of China between March 2023 and February 2024. Patients were divided into an RS group or a non-RS group based on peak expiratory flow rate and pectoral muscle index. Propensity-score matching (PSM) was performed at a 1:4 ratio to adjust for age, gender, body mass index, smoking history, comorbidities, surgical approach, tumor maximum diameter, and lymph node metastasis status. Postoperative outcome measures were compared between the matched groups. Multivariate regression analysis was conducted to assess the independent impact of RS on postoperative outcomes. ResultsA total of 1074 patients were included before matching. After matching, 175 patients were enrolled, comprising 154 males (88.0%) and 21 females (12.0%), with a mean age of (62.70±9.03) years. Among them, 128 patients were in the RS group and 47 in the non-RS group. After PSM, compared with the non-RS group, the RS group demonstrated significantly shorter time to first ambulation [MD=4.000, 95%CI (3.000, 5.000), P<0.001], shorter chest tube retention time [MD=1.000, 95%CI (0.000, 1.000), P=0.006], and postoperative hospital stay [MD=1.000, 95%CI (1.000, 2.000), P<0.001], and significantly increased incidence of respiratory discomfort symptoms within 1 year postoperatively [RR=3.585, 95%CI (1.758, 7.308), P<0.001]. Multivariate regression analysis revealed that preoperative coexisting RS was an independent risk factor for prolonged time to first ambulation (P<0.001) and increased thoracic drainage volume on postoperative day 1 (P=0.005). ConclusionPreoperative RS in patients with NSCLC directly leads to delayed early postoperative ambulation and increased early thoracic drainage volume. However, no significant impact of preoperative RS on long-term postoperative outcomes was observed, indicating that respiratory muscle mass and function represent potential targets for interventions aimed at improving surgical outcomes.
