Respiratory Sarcopenia Is Associated With Postoperative Pulmonary Complications in Patients With Esophageal Cancer

Esophagectomy for esophageal cancer carries a high risk of postoperative pulmonary complications (PPCs), which impact mortality and quality of life. Respiratory sarcopenia, characterized by decreased respiratory muscle strength and mass, may contribute to PPC risk, but its role remains unclear. This prospective cohort study analyzed 88 patients who underwent esophagectomy (June 2021-June 2024). Respiratory sarcopenia was defined as the presence of both low maximum inspiratory pressure (MIP) and diaphragm thickness (DT), assessed using a respiratory pressure meter and ultrasound. PPCs were classified using the Clavien-Dindo grade > II. The incidence of PPCs was higher in patients with respiratory sarcopenia than those without (55% vs. 27%), based on unadjusted proportions. Bayesian logistic regression adjusting for age, smoking, and nutritional status showed that respiratory sarcopenia was strongly associated with PPCs (adjusted mean odds ratio: 2.79; 95% credible interval: 0.75-7.37), particularly pneumonia and prolonged hospitalization. Identifying and addressing respiratory sarcopenia preoperatively through inspiratory muscle training and nutritional support may reduce PPC risk and improve outcomes.