CT-derived myosteatosis as a predictor of postoperative outcomes in esophagogastric cancer surgery: a systematic review

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Introduction: Myosteatosis, reflecting impaired skeletal muscle quality and fatty muscle infiltration, has emerged as a potentially important marker of perioperative vulnerability in oncologic surgery. However, evidence regarding CT-derived muscle quality parameters and postoperative outcomes after esophagogastric cancer surgery remains heterogeneous. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE was searched for studies evaluating CT-derived muscle quality parameters and postoperative outcomes in adult patients undergoing elective surgery for esophageal or gastric malignancies. Data regarding CT methodology, muscle quality assessment, body composition parameters, and postoperative outcomes were extracted and narratively synthesized. Results: Twenty-two studies comprising 6,733 patients were included. Myosteatosis was consistently associated with major postoperative complications (Clavien-Dindo ≥ III), with reported effect sizes generally ranging from approximately 2 to 5 across multiple cohorts. Associations with overall morbidity, specific complications, and length of stay were more heterogeneous. In several studies, muscle quality demonstrated stronger prognostic associations than muscle quantity alone, while composite body composition measures integrating muscle quality with muscle quantity, adiposity, or functional parameters showed improved predictive performance. Discussion: CT-derived myosteatosis appears to be an important marker of major postoperative morbidity in esophagogastric oncologic surgery and may provide complementary prognostic information beyond muscle quantity alone. However, substantial methodological heterogeneity limits comparability between studies and clinical implementation. Future research should prioritize standardization of muscle quality assessment and validation of clinically accessible assessment approaches.

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