Multimodal Nutritional and Sarcopenia Assessment for Risk Stratification in Lung Cancer Surgery

This prospective observational cohort study aims to evaluate the prognostic value of multimodal nutritional status and sarcopenia assessment in patients undergoing lung cancer surgery. Postoperative complications, mortality, and prolonged hospital stay remain major clinical concerns in thoracic surgery. Although malnutrition and sarcopenia are recognized as important determinants of surgical outcomes, their combined and multidimensional evaluation has not been sufficiently studied. Adult patients undergoing anatomical lung resection for primary lung cancer will be included. Nutritional status will be assessed using serum biomarkers, inflammatory indices, and validated clinical nutritional scores. Sarcopenia will be evaluated using computed tomography-based muscle mass and density measurements, as well as ultrasonographic muscle thickness. These parameters will be analyzed in relation to postoperative complications, intensive care unit (ICU) requirement, length of hospital stay, and mortality. Multivariable analyses will be performed to identify independent predictors, and a combined risk stratification model will be developed. This study aims to improve preoperative risk assessment and to support personalized perioperative management strategies, including identification of patients who may benefit from targeted nutritional optimization and prehabilitation.

Inclusion Criteria: * Age ≥18 years * Patients undergoing anatomical lung resection (lobectomy or segmentectomy) for primary lung cancer * Availability of preoperative thoracic computed tomography (CT) within 30 days before surgery * Completion of preoperative nutritional assessment and ultrasonographic muscle measurements * Ability to provide written informed consent Exclusion Criteria: * Receipt of neoadjuvant chemotherapy, immunotherapy, or radiotherapy * Emergency surgery * Pneumonectomy * Combined resection of another organ during the same procedure * Inadequate or non-evaluable imaging or measurement data * Immunosuppressive therapy or presence of advanced/metastatic disease * Significant thoracic deformity or prior conditions interfering with muscle measurements * Refusal or inability to provide informed consent