ArticleEsophagus : official journal of the Japan Esophageal Society2026
Clinical predictors of early reflux and symptom severity after esophagectomy: a risk prediction tool.
Article in Esophagus : official journal of the Japan Esophageal Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReflux after curative esophagectomy is common and may persist, disrupting eating, sleep, and recovery, yet most prediction tools estimate risk only at a single late time point.
methodsWe retrospectively analyzed an esophagectomy derivation cohort (2018-2021; n = 488) and a temporal validation cohort (2023-2024; n = 143). Clinically significant reflux was defined as an EORTC QLQ-OES18 item 14 or 15 score ≥ 2. Time to first event within 12 months was modeled using a time-varying coefficient Cox model, and longitudinal symptom severity (1-4) was modeled using an ordinal mixed-effects model. Predictors were prespecified from routine pre-discharge variables. Model performance was assessed using time-dependent AUC and calibration.
resultsCox analysis linked distal/esophagogastric junction tumors and higher BMI to increased early reflux risk, while neoadjuvant therapy, older age, and a longer oral-to-solid diet interval were protective. The ordinal mixed model showed greater symptom severity in women and in patients with distal/esophagogastric junction tumors, but lower severity with neoadjuvant therapy. Interactions suggested slower early symptom escalation with older age and steeper escalation with higher BMI or shorter oral-to-intake intervals. The time-varying Cox model showed good discrimination, with time-dependent AUCs at 1, 3, and 6 months of 0.702, 0.766, and 0.794 in the development cohort, and 0.708, 0.767, and 0.716 in the external validation cohort, with good calibration.
conclusionsA pre-discharge, time-sensitive risk model with a web-based calculator may support risk-stratified early screening, education, and targeted supportive care after discharge to reduce reflux-related morbidity and protect postoperative health-related quality of life.
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