Preoperative inspiratory muscle weakness significantly raises the risk of pneumonia following esophagectomy.

• 19.7% of patients developed postoperative pneumonia after surgery.
• Preoperative muscle weakness correlated with an 18.1% increased risk of pneumonia (95% credible interval 5-33.6).
• Respiratory sarcopenia showed a potential 11.2% risk increase, but with less certainty.

Surgeons should assess inspiratory muscle strength preoperatively to better manage pneumonia risk in esophageal cancer patients.