Maarten van Egmond

12 Chapter 1 cardiac complications contribute highly to postoperative morbidity and mortality varying from 10 to 40%. 3,10,13 This is not different for patients with esophageal cancer undergoing surgery. Figure 1. The theoretical model according to Topp et al. 12 on the effects of preoperative physical functioning on postoperative functional recovery Esophageal cancer Esophageal cancer is an aggressive malignant disease with an overall estimated 5-years survival of 15 to 20%. 14,15 The incidence of esophageal cancer in The Netherlands has increased from 813 patients per year in 1990 to 2536 patients per year in 2019. 16,17 For approximately 50% of these patients, surgical resection of the esophagus (esophagectomy) with gastric tube reconstruction and radical lymphadenectomy is the primary curative therapy (Figure 2). 18 Esophagectomy is associated with a high risk of postoperative complications varying from 25 to 60%. 14,15,19,20 Most commonly reported complications are pneumonia, esophago-enteric leak from anastomosis, staple line or localized conduit necrosis and atrial dysrhythmia. 21 Neoadjuvant chemoradiotherapy usually precedes esophagectomy and leads to better long-term survival than surgery alone. 18 Although loss of body weight and muscle mass could already be present at diagnosis, it is known that neoadjuvant chemoradiotherapy may lead to a significant decrease in lean body mass and fat mass and is a potential risk factor for sarcopenia. 4,23 According to Cruz-Jentoft et al. 24 sarcopenia is defined as ‘ a progressive and generalized skeletal muscle