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This study aimed to identify the association of preoperative PMI with postoperative clinical outcomes in surgical esophageal cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PubMed, Web of Science and EMBASE databases were searched up to March 19, 2026. Primary outcome was the survival including the overall survival (OS) and disease-free survival (DFS). Secondary outcome was the postoperative complication such as the anastomotic leak and pneumonia. Hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were combined to assess the relationship of PMI with primary and secondary outcomes, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen studies with 3813 patients were included. As for primary outcomes, pooled results demonstrated that lower PMI was significantly related to worse OS (HR\u2009=\u20091.72, 95% CI: 1.31\u20132.26,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and DFS (HR\u2009=\u20092.15, 95% CI: 1.46\u20133.16,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and subgroup analyses based on the tumor type and neoadjuvant therapy manifested consistent results. As for secondary outcomes, it was identified that preoperative PMI was associated with the risk of postoperative complication (OR\u2009=\u20091.92,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), anastomotic leak (OR\u2009=\u20092.08,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), pneumonia (OR\u2009=\u20092.56,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), arrhythmia (OR\u2009=\u20091.73,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), cardiac complication (OR\u2009=\u20092.11,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04), dysphagia (OR\u2009=\u20094.05,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03) and mortality (OR\u2009=\u20092.85,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative PMI was significantly associated with postoperative clinical outcomes and lower PMI indicated shortened survival and increased risk of complication in esophageal cancer patients undergoing the surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04915-1","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:37:03Z","timestamp":1778762223000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of preoperative psoas muscle index with clinical outcomes in surgical esophageal cancer patients: a meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Yanli","family":"Ji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"issue":"24","key":"4915_CR1","doi-asserted-by":"publisher","first-page":"3108","DOI":"10.1097\/CM9.0000000000003420","volume":"137","author":"L Qi","year":"2024","unstructured":"Qi L, Sun M, Liu W, Zhang X, Yu Y, Tian Z, et al. 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All procedures performed in studies that involved human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"421"}}