Maarten van Egmond

13 General introduction 1 disorder that potentially leads to adverse outcomes including falls, fractures, physical disability and mortality ’. The prevalence of sarcopenia in patients with esophageal cancer awaiting neoadjuvant chemoradiation is 47 to 57% and may increase to 79% after neoadjuvant chemoradiation. 23,25 In disease-free patients, sarcopenia even continues to increase until 1 year postoperatively. 26 Figure 2. Schematic outline of the preoperative (a) and postoperative (b) situation A gastric tube has replaced the esophagus and lymph nodes have been removed. 22 Reproduced with permission from Nederlands Tijdschrift voor Geneeskunde. Sarcopenia is considered to be an independent predictor of postoperative pulmonary complications, and poor recovery in patients with esophageal cancer and can be influenced by physiotherapy. 27,28 In addition to sarcopenia, impairments in preoperative physical functioning further contribute to a higher risk of developing postoperative complications and a delayed postoperative recovery in patients treated with esophagectomy. 10 Physical functioning Physical functioning is part of the multi-dimensional concept of functional status, defined as ‘ a patient-oriented health outcome that contains aspects of individual daily functioning, including physical-, psychological-, and social factors ’ and is a firm predictor of postoperative complications and postoperative recovery. 29