Vakalou K, Dimaki A, Lazaridou L, Koumarelas KE, Schizas D, Christodoulidis G. Sarcopenia as a prognostic factor in gastric cancer patients undergoing gastrectomy: Implications for postoperative and long-term outcomes. World J Gastrointest Surg 2026; 18(10): 124479 [DOI: 10.4240/wjgs.124479]
Corresponding Author of This Article
Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Thessalia, Greece. gregsurg@yahoo.gr
Research Domain of This Article
Oncology
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review-article
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Vakalou K, Dimaki A, Lazaridou L, Koumarelas KE, Schizas D, Christodoulidis G. Sarcopenia as a prognostic factor in gastric cancer patients undergoing gastrectomy: Implications for postoperative and long-term outcomes. World J Gastrointest Surg 2026; 18(10): 124479 [DOI: 10.4240/wjgs.124479]
Kalliopi Vakalou, Alexandra Dimaki, Lydia Lazaridou, Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Thessalia, Greece
Konstantinos Eleftherios Koumarelas, Department of General and Orthopaedic Surgery, Spitalverbund Appenzell Ausserrhoden, Herisau 9100, Appenzell Ausserrhoden, Switzerland
Dimitrios Schizas, First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens 11527, Greece
Co-first authors: Kalliopi Vakalou and Alexandra Dimaki.
Author contributions: Vakalou K and Dimaki A contributed equally to this article as the co-first authors; Christodoulidis G designed the overall concept and outline of the manuscript; Lazaridou L, Koumarelas KE, Schizas D, and Christodoulidis G contributed to the discussion and design of the manuscript, the writing and editing of the manuscript, and the review of the literature; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Thessalia, Greece. gregsurg@yahoo.gr
Received: June 16, 2026 Revised: July 14, 2026 Accepted: July 27, 2026 Published online: October 27, 2026 Processing time: 115 Days and 23.8 Hours
Abstract
Gastric cancer is the fifth most common cancer worldwide. The primary way to treat gastric cancer is surgical gastrectomy. Sarcopenia is being increasingly recognized as a crucial factor in determining post-gastrectomy outcomes. However, conventional models used to determine surgical risk have long focused on clinical-pathologic characteristics and the tumor involvement. The purpose of this review is to assess whether sarcopenia is an unaccounted factor of postoperative, short-term, long-term and survival outcomes. Current research shows that sarcopenia is linked to increased risks of postoperative morbidity including infectious complications, anastomotic leakage, longer periods of hospitalization, and readmission. Moreover, studies have shown that the functional measures of sarcopenia predict short-term postoperative outcomes. Additionally, when malnutrition and sarcopenia co-exist, they exacerbate the risk for complications during both the perioperative period and postoperative recovery. Several studies have demonstrated a significant decrease in disease-free survival and overall survival for patients with sarcopenia compared to non-sarcogenic patients, while muscle quality and functional parameters are stronger predictors than quantity of muscle alone. Perioperative changes in body composition including post-gastrectomy muscle loss and alterations in adipose tissue further enhance the ability to assess risk and may provide more accurate prediction. The co-existing phenotypes such as obesity with sarcopenia and myosteatosis also showed even larger negative effects on survival. New evidence also supports the use of multimodal models that incorporate sarcopenia, resulting in better discrimination between high vs low risk patients than using staging systems alone. To conclude, sarcopenia is an independent predictor, which can help to preoperatively identify patients at highest risk for postoperative complications and guide personalized interventions.
Core Tip: Sarcopenia is increasingly recognized as a clinically important predictor of outcome in patients undergoing gastrectomy due to gastric cancer. Reduced skeletal mass, muscle quality, and functional performance contribute to postoperative morbidity and long-term prognosis. Systemic inflammation and adipose tissue distribution also play a significant role. This review highlights the growing need for multidimensional assessment models that incorporate computed tomography-derived body composition markers as well as functional tests and markers of nutritional-inflammatory activity. Incorporating sarcopenia into preoperative risk stratification may improve patient selection. Finally, it may guide perioperative optimization and support more personalized surgical and oncological management.
