Prediction of dumping after oesophageal cancer surgery
DOI:
https://doi.org/10.2340/1651-226X.2026.45044Keywords:
Oesophageal neoplasms, dumping syndrome, prediction models, postoperative complications, survey', questionnairesAbstract
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.
Downloads
References
Hertz AF. The cause and treatment of certain unfavourable after-effects of gastro-enterostomy. Proc Roy Soc Med. 1913;6:155–63.
https://doi.org/10.1177/003591571300601929 DOI: https://doi.org/10.1177/003591571300601929
Berg P, McCallum R. Dumping syndrome: a review of the current concepts of pathophysiology, diagnosis, and treatment. Dig Dis Sci. 2016;61(1):11–18.
https://doi.org/10.1007/s10620-015-3839-x DOI: https://doi.org/10.1007/s10620-015-3839-x
Chen KN. Managing complications I: leaks, strictures, emptying, reflux, chylothorax. J Thorac Dis. 2014;6(Suppl 3):S355–63.
Scarpellini E, Arts J, Karamanolis G, Laurenius A, Siguini W, Suzuki H, et al. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol. 2020;16(8):448–66.
https://doi.org/10.1038/s41574-020-0357-5 DOI: https://doi.org/10.1038/s41574-020-0357-5
van Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017;18(1):68–85.
https://doi.org/10.1111/obr.12467 DOI: https://doi.org/10.1111/obr.12467
Arts J, Caenepeel P, Bisschops R, Dewulf D, Holvoet L, Piessevaux H, et al. Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol. 2009;7(4):432–7.
https://doi.org/10.1016/j.cgh.2008.11.025 DOI: https://doi.org/10.1016/j.cgh.2008.11.025
Boshier PR, Huddy JR, Zaninotto G, Hanna GB. Dumping syndrome after esophagectomy: a systematic review of the literature. Dis Esophagus. 2017;30(1):1–9.
https://doi.org/10.1111/dote.12488 DOI: https://doi.org/10.1111/dote.12488
Lin Y, Wang H, Qu Y, Liu Z, Lagergren P, Xie SH. Occurrence of dumping syndrome after esophageal cancer surgery: systematic review and meta-analysis. Ann Surg Oncol. 2025;32(2):791–800.
https://doi.org/10.1245/s10434-024-15881-x DOI: https://doi.org/10.1245/s10434-024-15881-x
Klevebro F, Boshier PR, Savva KV, Waller A, Hage L, Ni M, et al. Severe dumping symptoms are uncommon following transthoracic esophagectomy but significantly decrease health-related quality of life in long-term, disease-ree survivors. J Gastrointest Surg. 2021;25(8):1941–7.
https://doi.org/10.1007/s11605-020-04670-y DOI: https://doi.org/10.1007/s11605-020-04670-y
Anandavadivelan P, Wikman A, Malberg K, Martin L, Rosenlund H, Rueb C, et al. Prevalence and intensity of dumping symptoms and their association with health-related quality of life following surgery for oesophageal cancer. Clin Nutr. 2021;40(3):1233–40.
https://doi.org/10.1016/j.clnu.2020.08.005 DOI: https://doi.org/10.1016/j.clnu.2020.08.005
Sinha S, Padhy AK, Chattopadhyay TK. Dumping syndrome in the intra-thoracic stomach. Trop Gastroenterol. 1997;18(3):131–3.
Wang LS, Huang MH, Huang BS, Chien KY. Gastric substitution for resectable carcinoma of the esophagus: an analysis of 368 cases. Ann Thorac Surg. 1992;53(2):289–94.
https://doi.org/10.1016/0003-4975(92)91335-7 DOI: https://doi.org/10.1016/0003-4975(92)91335-7
Banki F, Mason RJ, DeMeester SR, Hagen JA, Balaji NS, Crookes PF, et al. Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg. 2002;236(3):324–35; discussion 35–6.
https://doi.org/10.1097/00000658-200209000-00009 DOI: https://doi.org/10.1097/00000658-200209000-00009
Peyre CG, DeMeester SR, Rizzetto C, Bansal N, Tang AL, Ayazi S, et al. Vagal-sparing esophagectomy: the ideal operation for intramucosal adenocarcinoma and barrett with high-grade dysplasia. Ann Surg. 2007;246(4):665–71; discussion 71–4.
https://doi.org/10.1097/SLA.0b013e318155a7a1 DOI: https://doi.org/10.1097/SLA.0b013e318155a7a1
Schandl A, Johar A, Anandavadivelan P, Vikstrom K, Malberg K, Lagergren P. Patient-reported outcomes 1 year after oesophageal cancer surgery. Acta Oncol. 2020;59(6):613–19.
https://doi.org/10.1080/0284186X.2020.1741677 DOI: https://doi.org/10.1080/0284186X.2020.1741677
Ludvigsson JF, Svedberg P, Olen O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol. 2019;34(4):423–37.
https://doi.org/10.1007/s10654-019-00511-8 DOI: https://doi.org/10.1007/s10654-019-00511-8
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.
https://doi.org/10.1186/1471-2458-11-450 DOI: https://doi.org/10.1186/1471-2458-11-450
Barlow L, Westergren K, Holmberg L, Talback M. The completeness of the Swedish Cancer Register: a sample survey for year 1998. Acta Oncol. 2009;48(1):27–33.
https://doi.org/10.1080/02841860802247664 DOI: https://doi.org/10.1080/02841860802247664
Brusselaers N, Lagergren J. The Charlson Comorbidity Index in registry-based research. Methods Inf Med. 2017;56(5):401–6.
https://doi.org/10.3414/ME17-01-0051 DOI: https://doi.org/10.3414/ME17-01-0051
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
https://doi.org/10.1016/0021-9681(87)90171-8 DOI: https://doi.org/10.1016/0021-9681(87)90171-8
Brooke HL, Talback M, Hornblad J, Johansson LA, Ludvigsson JF, Druid H, et al. The Swedish cause of death register. Eur J Epidemiol. 2017;32(9):765–73.
https://doi.org/10.1007/s10654-017-0316-1 DOI: https://doi.org/10.1007/s10654-017-0316-1
Collins GS, Moons KGM, Dhiman P, Riley R, Beam AL, Van Calster B, et al. TRIPOD plus AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. Bmj Brit Med J. 2024;385:e078378.
Deldycke A, Van Daele E, Ceelen W, Van Nieuwenhove Y, Pattyn P. Functional outcome after Ivor Lewis esophagectomy for cancer. J Surg Oncol. 2016;113(1):24–8.
https://doi.org/10.1002/jso.24084 DOI: https://doi.org/10.1002/jso.24084
Dirr V, Vetter D, Sartoretti T, Schneider MA, Da Canal F, Gutschow CA. Quality of life and independent factors associated with poor digestive function after ivor lewis esophagectomy. Cancers (Basel). 2023;15(23):5569.
https://doi.org/10.3390/cancers15235569 DOI: https://doi.org/10.3390/cancers15235569
Rubin DB. Multiple imputation for nonresponse in surveys. New York, NY: John Wiley & Sons; 1987.
Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Chapman & Hall, New York; 1984.
Scarpa M, Valente S, Alfieri R, Cagol M, Diamantis G, Ancona E, et al. Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol. 2011;17(42):4660–74. DOI: https://doi.org/10.3748/wjg.v17.i42.4660
https://doi.org/10.1002/9780470316696 DOI: https://doi.org/10.1002/9780470316696
Taioli E, Schwartz RM, Lieberman-Cribbin W, Moskowitz G, van Gerwen M, Flores R. Quality of life after open or minimally invasive esophagectomy in patients with esophageal cancer – a systematic review. Semin Thorac Cardiovasc Surg. 2017;29(3):377–90.
https://doi.org/10.1053/j.semtcvs.2017.08.013 DOI: https://doi.org/10.1053/j.semtcvs.2017.08.013
He Y, Wu YY, Wei W, Yang YB, Lin Y, Dai L. Dietary habits and nutrition status in esophageal cancer patients after esophageal reconstruction. J Thorac Dis. 2024;16(2):1118–27.
https://doi.org/10.21037/jtd-23-1266 DOI: https://doi.org/10.21037/jtd-23-1266
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Pernilla Lagergren, Laima Kampa, Kalle Mälberg, William Jebril, Johan Hardvik Åkerström, Asif Johar, Anna Schandl
This work is licensed under a Creative Commons Attribution 4.0 International License.
