Introduction: Esophagectomy is a high-risk operation often complicated by postoperative morbidity, especially anastomotic leakage, pulmonary complications, and prolonged hospitalization. Because sarcopenia reflects reduced physiologic reserve and impaired recovery potential, it may help identify patients at greater risk for poor short-term outcomes. Therefore, this study aimed to evaluate the impact of preoperative sarcopenia on short-term surgical complications, anastomotic leakage, and hospital stay.

Material and methods: This descriptive cross-sectional study included 75 adults undergoing elective esophagectomy at Imam Reza Hospital, Tabriz. Participants were recruited by convenience sampling. Preoperative sarcopenia was assessed using L3-level computed tomography to calculate the skeletal muscle index, and its associations with postoperative complications, anastomotic leakage, intensive care and hospital stay were evaluated using clinical and surgical data.

Results: Preoperative sarcopenia was associated with higher rates of overall complications, pulmonary complications, anastomotic leakage, surgical-site infection, atrial fibrillation, and 30-day readmission/mortality, as well as longer hospital and ICU stays. In adjusted analyses, sarcopenia remained an independent predictor of adverse outcomes, including overall complications (AOR 2.10, 95% CI 1.20–3.68; P=0.009), anastomotic leakage (AOR 2.35, 95% CI 1.01–5.47; P=0.047), pulmonary complications (AOR 2.80, 95% CI 1.40–5.60; P=0.003), major morbidity (AOR 2.65, 95% CI 1.30–5.40; P=0.007), and prolonged hospital stay (AOR 1.95, 95% CI 1.10–3.45; P=0.021).

Conclusion: Preoperative sarcopenia appears to be a clinically meaningful marker of poor short-term recovery after esophagectomy. Its association with increased postoperative complications and prolonged hospitalization supports routine preoperative muscle assessment to improve risk stratification and guide targeted perioperative optimization.