CT-Based Sarcopenia and Postoperative Outcomes After Lobectomy for Non-Small Cell Lung Cancer in Older Adults

Background/Objectives: Computed tomography-based sarcopenia is a marker of reduced physiological reserve, but evidence regarding organ-specific postoperative risk, particularly cardiac complications, remains limited in older patients undergoing lobectomy for non-small cell lung cancer (NSCLC). We evaluated postoperative outcomes and correlates of sarcopenia in this population. Methods: This single-center retrospective study included 147 patients aged ≥60 years undergoing lobectomy for primary NSCLC. Sarcopenia was defined from T12 skeletal muscle index using sex-specific cutoffs. The primary outcome was one-year all-cause mortality; secondary outcomes included postoperative complications. Results: Sarcopenia was present in 81 patients (55.1%). One-year mortality (12.3% vs. 10.6%; p = 0.743) and major postoperative complications did not differ by sarcopenia status. Cardiac complications were more frequent with sarcopenia (33.3% vs. 18.2%; p = 0.038; crude OR, 2.25; 95% CI, 1.03–4.90), although the association was attenuated after multivariable adjustment (adjusted OR, 2.05; 95% CI, 0.90–4.68; p = 0.087). Diabetes mellitus and larger tumor size were associated with higher odds of sarcopenia, whereas higher forced expiratory volume in one second (FEV1; % predicted) was associated with lower odds. Conclusions: Sarcopenia was common and identified a distinct preoperative phenotype. Its association with postoperative cardiac complications warrants further investigation; no association with one-year mortality was observed.