Loading
Life sciences · Journal article
European Journal of Medical Research · October 27, 2026
No summary has been generated for this record yet. What follows is drawn from its source metadata only.
Journal article.
No findings were extractable from the material analysed.
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
The source did not state who this applies to in practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
This record has not been graded across any dimension yet. Treat the label above as provisional and read the source.
What is missing. This record has no bottom line, key findings, reported figures, evidence dimensions. That is a gap in the analysis, not a judgement about the study.
Abstract Background Pulmonary complications remain common after esophagectomy. Risk assessment is particularly relevant after neoadjuvant therapy (NAT), which can worsen nutritional status and muscle reserve. Body mass index (BMI) is readily available, but its association with pulmonary complication risk may be nonlinear. Methods We performed a single-center retrospective cohort study at Shanxi Province Cancer Hospital. Among 364 neoadjuvant-treated patients with esophageal squamous cell carcinoma who underwent curative-intent esophagectomy, the primary endpoint was in-hospital pulmonary complications (pneumonia, pleural effusion requiring intervention, or pneumothorax). BMI was modeled as a continuous exposure using multivariable logistic regression and restricted cubic splines. Models were adjusted for demographic and clinical covariates, neoadjuvant regimen, and surgical route and approach. Modified Poisson regression with robust variance-estimated adjusted risk ratios were performed. Sensitivity analyses were additionally adjusted for anastomotic leak. Results Pulmonary complications occurred in 134/364 patients (36.8%). Patients with pulmonary complications had lower BMIs (22.43 ± 3.22 vs. 23.27 ± 2.91; P = 0.013) and more frequent anastomotic leak [48 (35.8%) vs. 45 (19.6%); P < 0.001]. In the adjusted linear BMI model, BMI was not significantly different [OR = 0.93 (0.86–1.01); P = 0.085]. In contrast, spline modeling revealed a significant overall association and nonlinearity [ P overall = 0.006; P nonlinear = 0.006], with a higher risk associated with a low BMI [18.5 vs. 22.8: OR = 2.879 (1.504–5.511)]. Estimates at higher BMIs were imprecise [28 vs. 22.8: OR 1.387 (0.751–2.559)]. Restricted cubic spline-based modified Poisson analysis revealed a directionally consistent nonlinear pattern, with excess risk concentrated at lower BMIs [BMI 18.5 vs. 22.8 kg/m 2: RR = 1.689 (95% CI 1.260–2.262)]. The spline association persisted after adjustment for anastomotic leak ( P overall = 0.004; P nonlinear = 0.006). Conclusions Preoperative BMI was nonlinearly associated with in-hospital pulmonary complications after neoadjuvant-treated esophagectomy, with the excess risk concentrated at low BMIs and greater uncertainty at BMI extremes. A possible increase in risk at higher BMIs requires validation in larger cohorts. In the neoadjuvant era, these findings support the interpretation of BMI as a nonuniform risk marker and provide hypothesis-generating evidence for perioperative optimization at the postneoadjuvant and preoperative time points, as well as for nutritional and prehabilitation strategies during neoadjuvant treatment to mitigate pulmonary risk.