Preoperative Sarcopenia and Major Postoperative Complications After Gastrectomy for Gastric Cancer: Does Adding Muscle Function to Muscle Mass Improve Risk Prediction? A Systematic Review and Meta-Analysis

Abstract

Background: Consensus bodies define sarcopenia by low muscle mass plus impaired function, yet most gastrectomy studies use computed-tomography muscle mass alone. Whether adding function improves prediction of major postoperative complications remains uncertain.

Objective: To quantify the association between preoperative sarcopenia and major complications after gastrectomy for gastric cancer and compare function-inclusive with imaging-mass-only definitions.

Case presentation: This systematic review and meta-analysis searched PubMed and Europe PMC through 17 June 2026 for adult gastrectomy cohorts reporting Clavien-Dindo grade IIIa or higher complications. Ten cohorts (4,883 patients) entered the primary pool. Sarcopenia increased the odds of major complications (OR 1.71, 95% CI 1.24–2.35; I² = 48.0%; prediction interval 0.73–3.99). Function-inclusive and imaging-mass-only definitions produced nearly identical estimates (OR 1.72, 95% CI 0.91–3.23, four cohorts, versus OR 1.71, 95% CI 1.12–2.62, six cohorts; interaction p = 0.997). The estimate remained stable in leave-one-out, cluster-selection, and exact-binomial sensitivity analyses, and no funnel asymmetry was detected.

Conclusion: Preoperative sarcopenia identifies higher-risk patients after gastrectomy. Adding muscle function did not increase the pooled association, but the function-inclusive subgroup was small and incomplete; the absence of a detected difference should not be interpreted as equivalence. Within-cohort evidence favored multidimensional assessment over a single muscle measure.