Gastrointestinal symptom profiles after resection of esophageal or gastric cancer

Persistent gastrointestinal symptoms are common after esophagectomy or gastrectomy, which frequently co-occur and significantly decrease quality of life. This study aimed to identify gastrointestinal symptom profiles over the first-year post-surgery and to explore changes over time.

Patients diagnosed between 2013 and 2024 who underwent esophagectomy or gastrectomy for nonmetastatic esophageal or gastric cancer were selected. Longitudinal self-reported gastrointestinal symptom data were linked to patient and tumor characteristics. K-means clustering based on symptom severity scores was performed at baseline and at every three months up to 12 months postoperatively. Generalized Linear Mixed Models assessed associations between patient characteristics and symptom profiles.

Among 1462 patients who underwent esophagectomy and 434 who underwent gastrectomy, three symptom severity profiles, mild, moderate, and severe, were identified for each period. These profiles reflected increasing symptom severity rather than distinct symptom patterns. The mild symptom profile was the most common (esophagectomy: 42.5 ~ 60.5%; gastrectomy: 53.9 ~ 73.5% across time periods). Most patients remained in the same profile over time. Amongst others, female sex (esophagectomy: OR = 1.67; 95% CI:1.30-2.14, gastrectomy: OR = 1.54; 95% CI:1.07-2.23) and receiving neoadjuvant chemotherapy (esophagectomy: OR = 1.91; 95% CI:1.22-2.99, gastrectomy: OR = 2.39; 95% CI:1.55-3.67) were associated with a higher likelihood of moderate/severe symptom profile.

Three stable gastrointestinal symptom severity profiles were identified during the first postoperative year, supporting risk-stratified monitoring after upper gastrointestinal cancer surgery. Early identification of patients at risk for persistent moderate-to-severe gastrointestinal symptoms may facilitate timely supportive care and improve survivorship outcomes.