Perioperative muscle preservation:an emerging concept of enhanced recovery after surgery and its clinical implementation

With the advancement of the enhanced recovery after surgery, the field of surgery has shifted from solely focusing on surgical techniques to comprehensively optimizing perioperative management. However, postoperative complications and delayed functional recovery remain signifi-cant challenges in major abdominal surgeries, such as those for gastrointestinal tumors. Skeletal muscle mass is a critical determinant of surgical tolerance, complication rates, and long‑term survival. Traditional notions of "sarcopenia" primarily address preoperative status, overlooking the profound impact of surgical trauma on muscle integrity. The authors introduce the novel integrated concept of perioperative muscle preservation (PMP), aiming to proactively prevent and reduce surgery‑related muscle loss through multimodal interventions spanning the preoperative, intraoperative, and post-operative phases, thereby preserving muscle mass and improving clinical outcomes. They systemati-cally elucidate the core physiological functions of skeletal muscle during the perioperative period, the mechanisms and consequences of muscle catabolism, and propose a bundled PMP management strategy centered on precision assessment, nutritional support, rehabilitation exercise, and metabolic regulation. This framework seeks to advance surgical practice toward a new era prioritizing physio-logical function preservation.