Sarcopenia defined by Asian Working Group for Sarcopenia 2025 criteria is associated with postoperative infectious complications after esophagectomy for esophageal cancer.

BACKGROUND

Sarcopenia is a predictor of postoperative infectious complications after esophagectomy and is modifiable by preoperative multimodal prehabilitation. The criteria of the Asian Working Group for Sarcopenia (AWGS) published in 2019 have been widely used to diagnose sarcopenia. However, that standard was developed for adults aged ≥65 years. The updated AWGS2025 extends the criteria to ages 50-64, but its association with postoperative infectious complications remains unclear. This study investigated the association between AWGS2025-defined sarcopenia and postoperative infectious complications after esophagectomy and described age-classified distributions.

METHODS

We reviewed 157 patients undergoing radical subtotal esophagectomy from 2019 to 2025. Sarcopenia was defined by AWGS2025 criteria using cutoff for handgrip strength and skeletal muscle mass. The primary outcome was postoperative infectious complications of Clavien-Dindo grade II or higher, including pneumonia, anastomotic leakage, surgical site infection, pyothorax, catheter-associated infection, Clostridioides difficile infection, and cellulitis. Logistic regression analysis was used to evaluate associations.

RESULTS

Sarcopenia was identified in 11 patients (7.0%), and postoperative infectious complications occurred in 40 patients (25.4%). Multivariable logistic regression showed that AWGS2025-defined sarcopenia was associated with postoperative infectious complications (OR 8.26; 95% CI 2.06-33.10; P = 0.002). In age-classified analyses, postoperative infectious complications occurred more frequently in patients with sarcopenia than in those without sarcopenia in both age groups (≥65 years: 66.7% vs 24.8%; <65 years: 40.0% vs 18.9%).

CONCLUSIONS

Sarcopenia defined by updated AWGS2025 criteria was associated with postoperative infectious complications after esophagectomy.