Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study

Body surface area (BSA) is a biometric unit to measure the body size. Its clinical significance in video-assisted thoracoscopic surgery (VATS) was rarely understood. We aimed to estimate the predictive value of BSA for surgical complications following VATS anatomical resections for lung adenocarcinoma (LAC).

A single-center retrospective analysis was performed on the consecutive patients between July 2014 and January 2016 in our institution. The differences in mean BSA values were evaluated between groups of patients classified by the development of postoperative surgical complications (PSCs), overall morbidity and cardiopulmonary complications, respectively. Receiver operating characteristic (ROC) analysis was performed to determine a threshold value of BSA on prediction of PSC occurrence. A multivariate logistic-regression model involving this optimal cut-off value and other significant parameters was established to identify the predictors for PSCs.

During the study period, a total of 442 patients undergoing VATS anatomical resections for LAC were enrolled in this study. There were 135 patients developed with one or more complications (rate = 30.5%). PSCs occupied the largest percentages of all these complications (n = 81, rate = 18.3%). The mean BSA in PSC group was significantly higher than that in non-PSC group (1.76 ± 0.15 m² vs 1.71 ± 0.16 m²; P = 0.016). No difference was found in mean BSA values between groups classified by any other complication. The ROC analysis determined a BSA value of 1.68 m² to be the threshold value with the maximum joint sensitivity of 72.8% and specificity of 48.5%. Compared to patients with BSA ≤ 1.68 m², patients with BSA > 1.68 m² had significantly higher incidences of prolonged air leak (P = 0.006) and chylothorax (P = 0.004). Further multivariate logistic-regression analysis indicated that BSA > 1.68 m² could be an independent risk factor for PSCs (odds ratio: 2.03; P = 0.025).

BSA is an excellent categorical predictor for surgical complications following VATS anatomical resections for LAC. It may be considered when informing patients about surgical risks and selecting cases in the early learning curve. Large-scale and multi-institutional studies are expected to confirm and modify our findings in the future.