Effect of Perioperative Physical Activity on Skeletal Muscle Loss 6 Months After Esophageal Cancer Surgery.

Background/Aim: Sarcopenia contributes to a poor prognosis in patients with esophageal cancer; thus, any clinical support that prevents loss of skeletal muscle mass preoperatively and postoperatively should be actively investigated. This study aimed to evaluate physical activity during the perioperative period and its impact on postoperative skeletal muscle mass. Patients and Methods: Sixty-two patients who underwent esophagostomy at the Hamamatsu University School of Medicine between 2019 and 2023 were evaluated. The physical activity (measured by the step count) of patients scheduled for esophagectomy was assessed preoperatively using a fitness tracker. The percentage change in skeletal muscle mass index (SMI) was calculated preoperatively and 6 months postoperatively. Factors associated with decreased SMI 6 months after esophagectomy were analyzed using multivariate analysis. Results: The median decrease in SMI was -6.2%. Multivariate analysis revealed that factors associated with the reduction of SMI were age >69 years [odds ratio (OR)=7.21, 95% confidence interval (CI)=1.36-38.19, p=0.020], preoperative step count <7,800 steps/day (OR=5.17, 95% CI=1.38-19.33, p=0.015), and postoperative step count <2,400 steps/day (OR=3.55, 95% CI=1.01-12.45, p=0.048). Conclusion: A low perioperative step count and older age were significant risk factors for skeletal muscle loss in patients with esophageal cancer undergoing surgery. For patients with a low number of steps in the perioperative period or for older patients, interventions to increase the number of steps may prevent skeletal muscle loss.