Possible Sarcopenia and Functional Decline After Colorectal or Gastric Cancer Surgery

While possible sarcopenia may influence short-term outcomes following gastrointestinal cancer surgery, its relationship with physical function at discharge remains poorly characterized. This study investigated the association between preoperative possible sarcopenia and functional decline at discharge.

This single-center retrospective cohort study included 200 consecutive patients who underwent elective colorectal or gastric cancer resection at Saitama Sekishinkai Hospital between January 2024 and August 2025. Possible sarcopenia was defined according to the Asian Working Group for Sarcopenia 2025 (AWGS 2025) criteria. Functional decline at discharge was defined as a decrease of ≥1 point in the Short Physical Performance Battery (SPPB) total score from the preoperative assessment to discharge. Modified Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs).

Of the 200 patients, 54 (27.0%) had possible sarcopenia and 37 (18.5%) showed functional decline at discharge. Functional decline occurred in 19 of 54 patients (35.2%) with possible sarcopenia and in 18 of 146 patients (12.3%) without possible sarcopenia. Possible sarcopenia was associated with functional decline in the crude model (RR=2.85, 95%CI=1.59-5.15; p<0.001), after adjustment for age and sex (RR=2.43, 95%CI=1.30-4.57; p=0.006), and after further adjustment for body mass index, Charlson Comorbidity Index, cancer location, surgical method, and preoperative SPPB scores (RR=2.15, 95%CI=1.09-4.25; p=0.027). Similar results were observed in patients aged ≥65 years.

Preoperative possible sarcopenia was independently associated with functional decline at discharge after colorectal or gastric cancer resection. Handgrip strength assessment may be a practical preoperative screening tool for identifying patients at risk and for planning perioperative rehabilitation or prehabilitation.