Patient-Reported Symptom Recovery After Upper Gastrointestinal Cancer Surgery: A Prospective Study Using the MDASI-UGI-Surg

BACKGROUND: Understanding patients' symptom recovery after upper gastrointestinal (UGI) cancer surgery is essential for patient-centered care, yet detailed longitudinal patient-reported outcome data remain limited. We conducted a prospective study using the novel MD Anderson Symptom Inventory for UGI Surgery (MDASI-UGI-Surg) tool. METHODS: Patients undergoing esophageal (n = 42), gastric (n = 27), or pancreatic (n = 74) cancer surgery from February to September 2024 were enrolled. The MDASI-UGI-Surg comprises 22 symptoms and 6 interference items. The five most severe symptoms and three most severe interference items on postoperative day (POD) 3 were identified. Recovery was defined as achieving mild severity for both symptom and interference composites. Multivariable analysis was performed to identify factors associated with recovery at postoperative month (POM) 1. RESULTS: Most symptoms peaked at POD3. The five most severe symptoms were pain, fatigue, sleep disturbance, drowsiness, and dry mouth; the top three interference items were general activity, working, and enjoyment of life. Symptom recovery followed three phases: an acute improvement phase (POD3-14), a plateau phase (POD14-POM1), and a persistent recovery phase extending to POM6. Symptom profiles were similar across organ groups, and fatigue remained prolonged. Cumulative recovery rates were 64.8% at POM1, 78.9% at POM3, and 90.8% at POM6. Postoperative complications and readmissions were associated with delayed recovery at POM1, and the type of surgery predicted recovery in multivariable models. CONCLUSIONS: This study provides a detailed characterization of symptom recovery after UGI cancer surgery. These findings support improved preoperative counseling and postoperative care planning.