Prediction of dumping after oesophageal cancer surgery

Introduction: Dumping syndrome is a common consequence following oesophagectomy and may lead to reduced food intake, resulting in subsequent weight loss, and negatively impact health-related quality of life. This study aimed to develop a predictive model to facilitate preventive treatment planning by identifying individuals at an increased risk of developing dumping syndrome.

Materials and methods: Data were obtained from a nationwide, population-based cohort of patients who underwent oesophagectomy for cancer between 2013 and 2020. Patient and clinical characteristics were retrieved from national health registries and medical records. Dumping symptoms were self-reported 1 year after surgery. Multivariable regression models provided odds ratios (OR) with 95% confidence intervals (CI). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC).

Results: Among the 384 individuals, 41 (11%) developed significant symptoms of dumping. The following variables that increased the probability of developing dumping were included in the final prediction model: younger age, female sex, higher preoperative body mass index, no neoadjuvant therapy, Charlson Comorbidity Index score > 0, open oesophagectomy, cervical anastomosis, and less severe postoperative complications (lower Clavien Dindo grade). For the prediction of early dumping symptoms, the AUC for the total cohort was 0.74 (95% CI: 0.64-0.83) and after cross-validation, 0.62 (95% CI: 0.53-0.72). For early and late symptoms, the AUC was 0.75 (95% CI: 0.67-0.83), and for the cross-validated model, 0.65 (95% CI: 0.56-0.74).

Interpretation: This study offers insights into factors associated with dumping syndrome after oesophagectomy. The prediction model showed modest ability to distinguish between high and low-risk patients, and should therefore be interpreted as supportive rather than definitive. Its potential value lies in complementing clinical judgement, informing structured follow-up and guiding future research.