Sarcopenia in esophageal cancer: causes, clinical implications and future directions—a narrative review

Background and Objective: Sarcopenia is a progressive reduction of muscle mass and function during lifetime, very common in elderly and during chronic diseases. Malnutrition, inflammation, advanced age, neoadjuvant therapies and cancer itself emerged as the most important causes of sarcopenia. Having a sarcopenic status may affect peri- and post-operative outcomes of surgical patients. This review aims to evaluate the impact of sarcopenia in postoperative outcomes in patients undergoing surgery for esophageal cancer. Methods: An extensive literature search was conducted on PubMed/MEDLINE, Scopus, and Web of Science, covering English publications from January 2000 to February 2025. Using the advanced search tool, titles and abstracts were filtered based on the following keywords and their combinations: “sarcopenia”, “esophageal cancer”, “esophagectomy”, “muscle mass”, “skeletal muscle index”, “nutritional status”, “prognosis”, “postoperative complications”, and “outcomes”. Key Contents and Findings: Perioperative sarcopenia in patients with esophageal cancer is associated with increased postoperative complications, prolonged hospital stays, and poorer prognosis, although some studies have reported conflicting results. After surgery, sarcopenia may further worsen due to malnutrition, immobility, and metabolic stress, thereby increasing the risk of respiratory complications, infections, and delayed wound healing. Conclusions: Sarcopenia is strictly related to major complications and decrease of overall survival (OS) in patients undergoing esophagostomy for cancer. The pre-operative assessment for sarcopenia and implementation of target supportive therapies can lead a lower complication rate and a better prognosis for operated patients for esophageal cancer.