Sarcopenia worsens overall survival following robotic esophagectomy for esophageal cancer

Sarcopenia is a recognized independent risk factor associated with poor outcomes in cancer patients undergoing surgery. Patients with esophageal cancer are particularly susceptible to sarcopenia due to multiple factors. Purpose of the current study was to investigate the effect of sarcopenia on outcome and survival in patients undergoing full-robotic esophagectomy. This study includes all patients who underwent full-robotic abdominothoracic esophagectomy for esophageal cancer between January 2019 and December 2022. The skeletal muscle index, assessed by the preoperative computed tomographic staging scan, was used to classify the study cohort into a sarcopenic and a non-sarcopenic group. A total of 206 cases were included. With 168 patients (82%), prevalence of sarcopenia was high in the study population. The proportion of older (65.3 vs. 60.7 years, p = 0.0115), male (86% vs. 72%, p = 0.0469) and patients with tumor stenosis and/or dysphagia after completion of neoadjuvant therapy (71% vs. 44%, p = 0.0035) in the sarcopenic group was significantly higher than in the non-sarcopenic group. Sarcopenia did not affect short-term outcomes including complication rates. However, overall- (17.4 vs. 22.8 months, p = 0.0458) and disease-free survival (15.3 vs. 22.6 months, p = 0.0069) was significantly reduced in sarcopenic patients. Preoperative sarcopenia was not associated with altered short-term outcomes but reduced overall- and disease-free survival. These findings underscore the critical need for prehabilitation and nutritional support for sarcopenic patients undergoing full-robotic esophagectomy, a complex procedure with inherently high morbidity.