Comparative clinical utility of preoperative psoas muscle and skeletal muscle index cutoffs for risk stratification after esophagectomy
- 1Department of Rehabilitation, Kindai University Hospital, 1-14-1 Mihara-dai, Minami-ku, Sakai, Osaka Japan
- 2Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
- 3Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, Osaka, Japan
Abstract
Purpose: To compare the clinical utility of preoperative psoas muscle index (PMI) and skeletal muscle index (SMI) cutoff stratification for predicting postoperative pulmonary complications (PPCs) and survival after esophagectomy.
Methods: This single-center retrospective study included 334 patients who underwent esophagectomy for thoracic esophageal cancer. Preoperative SMI and PMI were measured on CT images at the L3 level and classified using established cutoff values. Associations with PPCs were examined using multivariable logistic regression. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were evaluated.
Results: PPCs occurred in 110 patients in the study. The low-PMI group had significantly higher rates of PPCs and pneumonia than the no low-PMI group, whereas no significant differences were observed between the SMI-based groups. In a multivariable analysis, a low PMI was independently associated with PPCs (OR 2.17, 95% CI 1.16–4.07; p = 0.02), but a low SMI was not. The low-PMI group showed worse 5-year OS and RFS in unadjusted analyses, whereas SMI was not associated with these outcomes. In Cox regression analyses adjusted for other prognostic factors, the association between a low PMI and long-term outcomes was attenuated.
Conclusions: The preoperative PMI was more strongly associated with PPCs after esophagectomy than SMI. Although unadjusted analyses indicated an association, a low-PMI did not independently predict worse long-term outcomes in the adjusted analyses.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00595-026-03433-7.
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BibTeX
@article{mizusawa2026comparative,
title = {{Comparative clinical utility of preoperative psoas muscle and skeletal muscle index cutoffs for risk stratification after esophagectomy}},
author = {Hiroki Mizusawa and Osamu Shiraishi and Yuji Higashimoto and Masashi Shiraishi and Masaya Noguchi and Kengo Kanki and Honoka Natsume and Tomomi Tamura and Takushi Yasuda},
journal = {Surgery Today},
year = {2026},
month = jul,
doi = {10.1007/s00595-026-03433-7},
url = {https://doi.org/10.1007/s00595-026-03433-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative clinical utility of preoperative psoas muscle and skeletal muscle index cutoffs for risk stratification after esophagectomy
AU - Hiroki Mizusawa
AU - Osamu Shiraishi
AU - Yuji Higashimoto
AU - Masashi Shiraishi
AU - Masaya Noguchi
AU - Kengo Kanki
AU - Honoka Natsume
AU - Tomomi Tamura
AU - Takushi Yasuda
PY - 2026
DA - 2026/07/23
JO - Surgery Today
DO - 10.1007/s00595-026-03433-7
UR - https://doi.org/10.1007/s00595-026-03433-7
AB - Purpose: To compare the clinical utility of preoperative psoas muscle index (PMI) and skeletal muscle index (SMI) cutoff stratification for predicting postoperative pulmonary complications (PPCs) and survival after esophagectomy. Methods: This single-center retrospective study included 334 patients who underwent esophagectomy for thoracic esophageal cancer. Preoperative SMI and PMI were measured on CT images at the L3 level and classified using established cutoff values. Associations with PPCs were examined using multivariable logistic regression. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were evaluated. Results: PPCs occurred in 110 patients in the study. The low-PMI group had significantly higher rates of PPCs and pneumonia than the no low-PMI group, whereas no significant differences were observed between the SMI-based groups. In a multivariable analysis, a low PMI was independently associated with PPCs (OR 2.17, 95% CI 1.16–4.07; p = 0.02), but a low SMI was not. The low-PMI group showed worse 5-year OS and RFS in unadjusted analyses, whereas SMI was not associated with these outcomes. In Cox regression analyses adjusted for other prognostic factors, the association between a low PMI and long-term outcomes was attenuated. Conclusions: The preoperative PMI was more strongly associated with PPCs after esophagectomy than SMI. Although unadjusted analyses indicated an association, a low-PMI did not independently predict worse long-term outcomes in the adjusted analyses. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00595-026-03433-7.
SN - 0941-1291
SN - 1436-2813
ER -