[Preoperative nutritional support in patients with esophageal cancer]

Major surgery is essential in the treatment of esophageal cancer. Nutritional depletion may play some role in a high likelihood of postoperative complication following esophagectomy. The aim of this study was to determine whether preoperative nutritional support could restore the nutritional status and reduce the incidence of postoperative pneumonia in malnourished patients with esophageal cancer. Fifty-one malnourished patients undergoing transthoracic esophagectomy were studied (group I: 19 patients, 70 years of age or older; group II: 32 patients, 69 years of age or younger). All of them received nutritional support of 30 kcal/kg/day or more by either the parenteral or enteral route for a week or more. These patients were followed for postoperative pneumonia. The relationship between response to preoperative nutritional support and postoperative pneumonia was examined. Sixteen out of 51 patients (31%) demonstrated a loss in weight and rise in serum albumin following the institution of nutritional support, i.e., good response. Out of 11 patients in group II who exhibited a good response to nutritional support, only one (9%) developed pneumonia postoperatively. By contrast, out of 14 in group I who showed a poor response to nutritional support, five (36%) developed pneumonia following esophagectomy. From these results, it is concluded that nutritional support can benefit malnourished esophageal cancer patients. However, further points remain to be elucidated to improve the nutritional status of patients more than 70 years old.