Muscle Quantity Meets Muscle Quality: Integrating Skeletal Muscle Index and Hand Grip Strength to Predict Surgical Risk in Esophago-Gastric Cancer.

BACKGROUND AND OBJECTIVES: Sarcopenia influences surgical outcomes in patients with upper gastrointestinal malignancies. Skeletal muscle index (SMI) reflects muscle mass, while hand grip strength (HGS) reflects muscle function. Their combined value in predicting postoperative risk after esophago-gastric cancer surgery remains uncertain. This study evaluated the individual and combined predictive value of preoperative SMI and HGS for major postoperative complications after curative surgery for esophageal and gastric cancers. METHODS: In this prospective observational study, 150 adults undergoing radical esophagectomy or gastrectomy for biopsy-proven esophageal or gastric cancer between September 2022 and June 2024 were enrolled at a tertiary referral center. SMI was derived from CT at the L3 level using Asian-specific thresholds, and HGS was measured using a standardized hand dynamometer. The primary outcome was major postoperative complications (Clavien-Dindo grade ≥III). Secondary outcomes included pulmonary complications, ICU stay, hospital stay, and 90-day mortality. Logistic regression and receiver operating characteristic analyses were performed. RESULTS: Major complications occurred in 33 patients (22%). Weak HGS and weak SMI were each associated with higher complication rates (36.1% vs 9.0% and 36.6% vs 8.9%; p = 0.0001). Combined weakness resulted in 60.6% major complications versus 15.6% with one abnormal parameter and 2.5% when both were preserved. The combined model showed superior discrimination (AUC 0.88) compared with SMI (0.79) or HGS (0.81). Combined weakness independently predicted major complications (OR 31.3, p = 0.002). CONCLUSIONS: Combined assessment of SMI and HGS improves prediction of postoperative morbidity after esophago-gastric cancer surgery and may enhance preoperative risk stratification.