Preoperative sarcopenia predicts complications and non-cancer specific mortality in esophageal cancer surgery

Sarcopenia, a condition characterized by decreased muscle mass and strength, has been reported to worsen the prognosis of patients with malignancies potentially. However, its impact on short- and long-term outcomes after esophagectomy for esophageal cancer remains unclear. This study aimed to investigate the influence of preoperative sarcopenia on postoperative complications and survival outcomes after esophagectomy. This retrospective study included 187 patients with esophageal cancer who underwent curative esophagectomy at our hospital between 2014 and 2023. Patients were classified into sarcopenia and non-sarcopenia groups based on their preoperative skeletal muscle index (SMI) measured using bioelectrical impedance analysis (BIA). The relationships between sarcopenia and short- and long-term outcomes were analyzed. Sarcopenia was identified in 43.9% (n = 82) of the patients. The sarcopenia group had a significantly higher incidence of postoperative pneumonia than the non-sarcopenia group (31.7% vs. 13.3%, P = 0.004). Survival analysis revealed that the sarcopenia group exhibited poorer overall survival (OS) and non-cancer-specific survival (NCSS) than the non-sarcopenia group. Multivariate analysis demonstrated that sarcopenia was an independent risk factor for postoperative pneumonia in the short term (odds ratio: 2.805, P = 0.007), as well as for poor OS (hazard ratio: 1.994, P = 0.032) and NCSS (hazard ratio: 4.058, P = 0.023) in the long term. Preoperative sarcopenia was an independent predictor of postoperative pneumonia following curative esophagectomy. Sarcopenia has been identified as a risk factor for reduced OS and NCSS. SMI measurement using BIA may be useful for preoperative risk assessment and informing treatment strategies.