Impact of Preoperative Sarcopenia on Patient Survival After Esophagectomy for Cancer: A Retrospective Cohort Study

Introduction: The prevalence of sarcopenia exhibits considerable variation depending on patient age, definitions, diagnostic techniques, and classifications. Previous studies showed that sarcopenia in patients with esophageal cancer might increase the risk of postoperative complications. However, its impact on overall (OS) and disease-free survival (DFS) is unclear. Methods: Retrospective multicenter study (January 2014 to December 2024), including patients with resectable Siewert I-II esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy. Sarcopenia was assessed by using the Psoas Muscle Index (PMI), calculated at the level of the third lumbar vertebra on preoperative CT scan. Results: Overall, 338 patients were included; 79.5% were male, and the median age was 66 years. The prevalence of sarcopenia was 39.7%. Anastomotic leak (21.6% vs. 10.8%; p = 0.02), pneumonia (14.9% vs. 6.4%; p = 0.02), and 90-day mortality (7.5% vs. 1.9%; p = 0.03) were significantly higher in sarcopenic patients. On multivariate analysis, sarcopenia was an independent predictor of anastomotic leak (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.12-1.87), pneumonia (OR 1.84, 95% CI 1.24-2.15), and 90-day mortality (OR 1.21, 95% CI 1.05-1.55). The 60-month DFS (32% vs. 52%; p = 0.001) and OS (47% vs. 61%; p = 0.008) were significantly reduced in sarcopenic patients. Sarcopenia was an independent predictor of poor survival in the regression analysis (hazard ratio [HR] 1.84, 95% CI 1.36-2.78). Conclusions: Sarcopenia is a highly prevalent condition among patients with esophageal adenocarcinoma. Patients with sarcopenia have lower DFS and OS rates compared with those without sarcopenia. Sarcopenia was independently associated with postoperative anastomotic leak, pneumonia, 90-day mortality, and poor long-term survival.