Journal of Geriatric Oncology · Jun 3, 2026

Interaction between locomotive syndrome and baseline walking capacity predicts postoperative endurance decline in gastrointestinal cancer surgery

By Asaeda M, Nakashima Y, Fukukahara K et al.

INTRODUCTION: Locomotive syndrome (LS) is characterized by impaired mobility from musculoskeletal dysfunction and is associated with future disability and mortality. Its perioperative relevance in gastrointestinal (GI) cancer remains unclear. This study aimed to determine if preoperative LS and its severity predict diminished postoperative physical function at discharge following GI cancer surgery. MATERIALS AND METHODS: This single-center, retrospective cohort study included adults undergoing elective, curative-intent surgery for GI malignancies between February 2023 and June 2025 at a university hospital. Preoperative LS was assessed using the Japanese Orthopaedic Association test battery, categorizing patients into stages 0-3 (LS absent vs. present). Physical function was evaluated using various measures. The primary outcome was postoperative function at discharge, with change scores (Δ) calculated from baseline. Group comparisons and analysis of covariance (ANCOVA) models were used to evaluate Δ6-min walk distance (6MWD), Δgrip strength, ΔTimed Up-and-Go (ΔTUG), and Δskeletal muscle mass index (ΔSMI), while adjusting for age, sex, body mass index, the pre- to postoperative assessment interval, and the corresponding preoperative value. An interaction term was included to test LS × preoperative function. RESULTS: Of 339 patients screened, 75 were included in the final analysis. Preoperatively, 19 patients were classified as (LS) stage 0, 14 as stage 1, 14 as stage 2, and 28 as stage 3. In ANCOVA for change in Δ6MWD, LS status was independently associated with Δ6MWD. A significant LS × preoperative 6MWD interaction indicated that the effect of LS on postoperative endurance loss differed according to baseline walking capacity. For grip strength and TUG, neither LS status nor LS × baseline interactions were significant, while for SMMI, baseline value and sex were significant predictors. DISCUSSION: Preoperative LS modifies the association between baseline walking capacity and early postoperative decline in walking endurance after GI cancer surgery. These findings support routine assessment of both LS and 6MWD to improve perioperative risk stratification and to inform targeted prehabilitation, including endurance-focused interventions for high-risk patients.

doi.org/10.1016/j.jgo.2026.103025Open accessPubMed 42235282Biomarkers