Purpose <p>This study aimed to chart the trajectory of predicted postoperative nutritional risk in patients with oesophageal cancer and to explore further the impact of patients’ postoperative symptom burden on the nutritional risk trajectory.</p> Method <p>The nutritional risk of patients with oesophageal cancer was assessed using the geriatric nutritional risk index (GNRI), prognosis nutritional index (PNI), and lymphocyte count, and symptom burden was assessed using the Convalescent Symptom Assessment Scale for Oesophagectomy Patients. The trajectory of postoperative nutritional change in patients was depicted using unconditional free estimation Latent Growth Curve Model (LGCM), and factors influencing the trajectory of nutritional risk change and the effect of symptom burden on the trajectory of nutrition were explored using conditional LGCM.</p> Results <p>Postoperative nutritional risk of patients with oesophageal cancer generally declined 1–2&#xa0;days after surgery. The GNRI declined by less than 10%, the PNI by more than 20%, and the change in lymphocyte counts dropped by more than 60%. Gender, residence, chronic diseases, healthcare payment methods, and chemotherapy were significant factors influencing patients’ nutritional risk changes. Overall symptoms at 1–2&#xa0;days postoperatively affect initial postoperative levels of PNI, overall and late symptoms affect initial postoperative levels of lymphocytes, while late and psychological symptoms affect the rate of lymphocyte recovery.</p> Conclusion <p>Postoperative days 1–2 are a critical period for nutritional risk in patients with oesophageal cancer, when symptom burden affects the trajectory of changes in nutritional risk. Medical personnel can improve the nutritional risk of patients by reducing the symptom burden.</p>