对于非小细胞肺癌（NSCLC）患者而言，分段切除术被认为比肺叶切除术更具侵袭性较低的手术。然而，关于分段切除术侵袭性较低的生理机制了解甚少。本研究旨在比较NSCLC患者中，分段切除术和肺叶切除术后长期股筋肉质量变化的差异。共纳入2016年1月至2018年12月间进行临床0-I期NSCLC的315例无复发患者，其中93例接受了分段切除术，222例接受了肺叶切除术，均于手术后0.5至48个月内（分为POY区间）进行了电子计算机断层扫描。通过每个患者的横截面计算机断层扫描，测量了第3腰椎水平处背侧两侧股筋肌面积（PMA）。使用Student's t检验和混合方差分析比较了分段切除术组和肺叶切除术组术后PMA平均变化的差异。通过逻辑回归分析进行多变量分析，以确定POY 3阶段PMA丧失风险因素。肺叶切除术组在每个术后期间的PMA变化明显大于分段切除术组（P <0.001）。混合方差分析揭示，观察期间，分段切除术组PMA平均变化显著小于肺叶切除术组（P <0.001）。肺叶切除术组在POY1期（-2.5%）到POY2期（-3.9%）和POY3期（-4.7%）中的PMA变化显著大于分段切除术组（P = 0.003和P <0.001）。然而，分段切除术组的PMA在术后观察期间保持不变。在多变量分析中，POY3期PMA变化≤-3.3%（PMA平均变化量的分界值）的风险因素包括肺叶切除术（OR，3.32；95% CI，1.90-5.82；P <0.001）、男性（OR，1.92；95% CI，1.02-3.62；P = 0.044）和开胸胸腔镜手术（OR，1.84；95% CI，1.11-3.05；P = 0.017）。在比例得分匹配后，分段切除术组（n = 75）在术后观察期间的PMA变化较肺叶切除术组（n = 75）显著较小（P <0.001）。分段切除术比肺叶切除术更好地维持了术后期间的股筋肌质量。肺叶切除术后，术后长时间逐渐出现股筋肉减少。完全经视频辅助胸腔镜下的分段切除术与肌肉萎缩进展的可能性较低相关。 ©2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle 由Wiley Periodicals LLC 出版.

Segmentectomy is considered a less invasive procedure than lobectomy for patients with non-small cell lung cancer (NSCLC); however, little is known about the physiological mechanism underlying the lower invasiveness of segmentectomy. This study is aimed to compare the differences in the long-term changes in the psoas muscle mass after segmentectomy and lobectomy in patients with NSCLC.Overall 315 recurrence-free patients who underwent segmentectomy (n = 93) or lobectomy (n = 222) for clinical stage 0-I NSCLC between January 2016 and December 2018 and underwent computed tomography during the entire period of 6 months ≤ postoperative year (POY) 0.5 < 12 months, 12 months ≤ POY 1 < 24 months, 24 months ≤ POY 2 < 36 months, and 36 months ≤ POY 3 < 48 months were included. Bilateral psoas muscle area (PMA) at the L3 level was measured using each cross-sectional computed tomography scan. Differences between the segmentectomy and lobectomy groups in the mean change of postoperative PMA from the preoperative period were analysed using Student's t-test and mixed analysis of variance. Multivariable analysis was performed to identify the risk factors for PMA loss on POY 3 using logistic regression analysis.The lobectomy group had a significantly larger PMA change than the segmentectomy group during each postoperative period (P < 0.001). Mixed analysis of variance revealed that the mean PMA change was significantly smaller in the segmentectomy group than in the lobectomy group during the observation period (P < 0.001). The mean change in the PMA was significantly larger from POY1 (-2.5%) to POY2 (-3.9%) and POY3 (-4.7%) in the lobectomy group (P = 0.003 and P < 0.001). However, PMA remained unchanged during the postoperative observation period in the segmentectomy group. In the multivariable analysis, the risk factors for PMA change ≤-3.3% (cut-off: mean change of PMA) at POY3 included lobectomy [odds ratio (OR), 3.32; 95% confidence interval (CI), 1.90-5.82; P < 0.001], male sex (OR, 1.92; 95% CI, 1.02-3.62; P = 0.044) and open thoracotomy (OR, 1.84; 95% CI, 1.11-3.05; P = 0.017). After propensity score matching, the mean change in PMA was smaller in the segmentectomy group (n = 75) than in the lobectomy group (n = 75) during the postoperative observation period (P < 0.001).Psoas muscle mass was better maintained during the postoperative period by segmentectomy than by lobectomy. Psoas muscle mass reduction progressed over a long postoperative period after lobectomy. Segmentectomy via complete video-assisted thoracic surgery is associated with a lower likelihood of sarcopenia progression.© 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.