Longitudinal trends of dumping syndrome after oesophageal cancer surgery

Postprandial dumping syndrome is a common complication following oesophageal cancer surgery, yet its long-term course and impact on eating and weight loss remain unclear. This study aimed to evaluate the prevalence of dumping syndrome and its association with eating difficulties and weight loss after oesophageal cancer surgery.

This study is part of the nationwide prospective OSCAR cohort, which includes patients who underwent oesophageal cancer surgery in Sweden between 2013 and 2020 and survived the first postoperative year. Patients were included at 1 year post-surgery, with follow-up data up to 5 years post-surgery. Dumping syndrome was assessed using the OSCAR dumping questionnaire, and eating difficulties were measured with the EORTC QLQ-OG25. Weight data were obtained from medical records (preoperative), objective measurements (1-year baseline), and self-reports (follow-ups). Associations between dumping syndrome, eating difficulties, and weight loss were analysed using linear mixed models adjusted for potential confounders.

In total, 415 patients were included in the OSCAR cohort, of whom 385 completed the dumping questionnaire one year after surgery. At 1 year post-surgery, early dumping syndrome was reported by 53.0% of patients, including 19.0% with severe symptoms, while late dumping syndrome was reported by 10.9%, including 3.1% with severe symptoms. At 5 years post-surgery, early and late dumping syndrome were reported by 61.6% and 11.6% of 138 patients, respectively, with no significant change in severity distribution. Severe dumping syndrome was associated with higher eating difficulty scores at 1 year (p < 0.001) but not at 5 years post-surgery. Severe early dumping was associated with greater weight loss (%) compared with non-symptomatic patients at 1 year (mean difference [MD] 2.7%; 95% CI 0.4 to 5.0) and at 5 years (MD 3.4%; 95% CI -0.3 to 7.0).

Dumping syndrome is common and persists after oesophageal cancer surgery. Severe dumping syndrome is associated with greater eating difficulties and weight loss, highlighting the need for improved dietary management. In addition, a validated patient-reported diagnostic instrument is needed to reduce the risk of symptom misreporting.