Prevalence of preoperative sarcopenia according to EWGSOP2 in patients with colorectal cancer and its impact on surgical outcomes: a prospective observational study

Sarcopenia may adversely affect postoperative outcomes, but most studies in colorectal cancer (CRC) have relied solely on computed tomography (CT)-derived muscle mass. We evaluated the association between a comprehensive assessment based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and short-term postoperative outcomes after curative CRC surgery. In this prospective observational study, 70 consecutive patients who underwent curative CRC resection between July 2024 and July 2025 were assessed for muscle strength (handgrip strength), physical performance (4-m gait speed), and muscle mass (L3 CT skeletal muscle index). According to EWGSOP2 criteria, patients were classified as non-sarcopenic or into the hierarchical cumulative stages of probable, confirmed, and severe sarcopenia. Postoperative outcomes included major complications and length of hospital stay. Of the 70 patients, 41 (58.6%) were non-sarcopenic, whereas 29 (41.4%) had at least probable sarcopenia; within this hierarchical group, 27 (38.6%) had confirmed sarcopenia and 18 (25.7%) had severe sarcopenia. Patients with at least probable sarcopenia were older and had lower body mass index and serum albumin levels (all p < 0.01). Across the hierarchical EWGSOP2 stages, the frequency of major postoperative complications increased compared with non-sarcopenic patients (probable 34.4%, confirmed 37.0%, severe 55.5% vs. 9.7%, respectively; p < 0.01), and hospital stay was significantly longer (9.3–10.6 vs. 6.1 days; p < 0.001). Tumor characteristics did not differ significantly between groups. In exploratory multivariable analysis, at least probable sarcopenia was associated with major postoperative complications (adjusted odds ratio [aOR] 11.75, 95% confidence interval [CI] 1.27–108.82; p = 0.030) and prolonged hospital stay (aOR 8.33, 95% CI 1.01–68.38; p = 0.049), although these estimates should be interpreted cautiously because of the small sample size and wide confidence intervals. EWGSOP2-based sarcopenia assessment was associated with worse short-term postoperative outcomes after curative CRC resection. Given the limited sample size and wide confidence intervals, these findings should be interpreted as exploratory and require external validation in larger prospective cohorts before clinical implementation. ClinicalTrials.gov Identifier: NCT06698289.