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Venugopalan A, Sirohiya P. Sarcopenia in gastrointestinal malignancies: Assessment, prognostic significance, and multidisciplinary management. World J Gastrointest Oncol 2026; 18(12): 125816 [DOI: 10.4251/wjgo.125816]
World J Gastrointest Oncol. Dec 15, 2026; 18(12): 125816 Published online Dec 15, 2026. doi: 10.4251/wjgo.125816
Sarcopenia in gastrointestinal malignancies: Assessment, prognostic significance, and multidisciplinary management
Aishwarya Venugopalan, Prashant Sirohiya
Aishwarya Venugopalan, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital (BRAIRCH), All India Institute of Medical Sciences (AIIMS), New Delhi 110029, Delhi, India
Prashant Sirohiya, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (Jhajjar), All India Institute of Medical Sciences (AIIMS), New Delhi 110029, Delhi, India
Author contributions: Venugopalan A and Sirohiya P conceptualized and designed the review; Venugopalan A conducted the literature search, screened and appraised the evidence, interpreted the data and drafted the original manuscript; Sirohiya P supervised the work and made critical revisions related to important intellectual content; both authors read and approved the final version of the manuscript to be published.
AI contribution statement: During the preparation of this manuscript, the authors used Claude (Anthropic) solely for grammar and language editing. No AI tool was used to generate scientific content, analyse data, or draw conclusions. The authors reviewed and edited all text and take full responsibility for the content of the publication.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Prashant Sirohiya, MD, Assistant Professor, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (Jhajjar), All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, Delhi, India. prashantsirohiya@aiims.edu
Received: July 17, 2026 Revised: August 8, 2026 Accepted: October 23, 2026 Published online: December 15, 2026 Processing time: 116 Days and 4.3 Hours
Abstract
Sarcopenia is the progressive and generalized loss of skeletal muscle mass and function. It is highly prevalent in gastrointestinal (GI) malignancies, particularly advanced disease. It has thereby emerged as a clinically important, potentially modifiable prognostic factor. It arises from a complex interplay of tumor-driven systemic inflammation, reduced nutritional intake, metabolic derangement and physical inactivity, and frequently overlaps with the syndrome of cancer cachexia. Computed tomography assessment of skeletal muscle at the third lumbar vertebra, obtained from routine staging imaging, is the most widely used method for quantifying muscle mass in oncology and provides the muscle-quantity component of consensus diagnostic frameworks such as the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, which require concurrent assessment of muscle strength. Across esophageal, gastric, colorectal, pancreatic, hepatocellular and biliary cancers, sarcopenia is consistently associated with: (1) More postoperative complications; (2) Greater chemotherapy dose-limiting toxicity; (3) Reduced efficacy of immune checkpoint inhibitors; (4) Impaired quality of life; and (5) Shorter survival. Management requires individualized nutritional support with adequate protein and energy provision, structured resistance and aerobic exercise, prehabilitation before major surgery, and pharmacological agents such as the ghrelin-receptor agonist anamorelin. Multimodal interventions combining these elements represent the most rational strategy, although robust GI-specific randomized evidence remains limited. This review summarizes current evidence and highlights priorities for standardized assessment and individualized treatment.
Core Tip: Sarcopenia is common in gastrointestinal cancers and independently predicts postoperative complications, treatment toxicity, reduced immunotherapy efficacy and poor survival. Opportunistic computed tomography analysis of skeletal muscle at the third lumbar vertebra allows practical, low-cost detection using imaging already performed for staging. Because its causes are multifactorial, effective management combines nutritional optimization, resistance and aerobic exercise, surgical prehabilitation and, in selected patients, pharmacotherapy such as anamorelin. Embedding routine muscle assessment and multimodal, multidisciplinary intervention into cancer care may improve outcomes in this vulnerable population.
