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Background  This study investigated the risk factors for severe weight loss (SWL) within one year after minimally invasive McKeown esophagectomy.    Methods  Esophageal cancer patients who underwent McKeown esophagectomy between January and July 2017 were prospectively enrolled. Preoperative body weight (PBW) was chosen as the initial body weight.    Results  Forty‐four patients were enrolled and successfully followed up for one year. Median weight loss was 7.4% (quartile: 5.3–8.1%) and 12.6% (quartile: 8.8–17.7%) four weeks and one year after surgery, respectively. Accelerated weight loss occurred during the first two weeks after discharge, with median weight loss of 5.6% (quartile: 4.2–7.1%). Multivariable analysis showed that age ≥ 70 years (odds ratio [OR] 7.65;  P  = 0.030), preoperative sarcopenia (OR 7.18;  P  = 0.030), the first surgery in the daily schedule (OR 6.87;  P  = 0.032) and vocal cord paralysis (OR 12.30;  P  = 0.046) were independent risk factors for short‐term (4 weeks) SWL (> 7.5% PBW), while an American Society of Anesthesiologists score of 3–4 (OR 6.58;  P  = 0.047), a high fat‐free mass (OR 21.91;  P  = 0.003), and vocal cord paralysis (OR 25.83;  P  = 0.017) were independent risk factors for long‐term (1 year) SWL (> 13.0% PBW) after esophagectomy. Postoperative symptoms of insomnia, appetite loss, dysphagia, eating difficulties, and taste issues were also related to SWL.    Conclusions  In esophageal cancer patients who have undergone esophagectomy, the first two weeks after hospital discharge is a key period for nutrition intervention. Patients with associated factors for SWL require postoperative nutrition support.

Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy