[Nutritional support for preoperative patients with esophageal cancer]

Nutritional support for patients undergoing major operations seems to be very important for improving the operative results, especially in preoperative patients with conditions such as esophageal carcinoma. In our department, patients who have lost more than 10% of their normal weight have been given intravenous hyperalimentation for at least two weeks preoperatively to prevent postoperative pulmonary complications. However good responses to nutritional support were not always obtained in these patients. One of the reasons was thought to be possible inadequacy of the nutritional support, for example, in the amount of energy intake. The purpose of this study was to clarify the energy requirements of anorexic patients by examining the relationship between energy expenditure and nutritional status. Fifty-three male patients with thoracic esophageal carcinoma given radical surgery were studied retrospectively. These patients were divided into two groups: group 1 consisted of 39 patients who had lost little or no weight (greater than or equal to 90% UsWt), and group 2 consisted of 14 patients who had lost more than 10% of their pre-illness weight (less than 90% UsWt). In order to estimate the energy requirement, resting energy expenditure (REE) was measured using indirect calorimetry and the formula of Weir, and compared with the basal energy expenditure (BEE) as predicted using the formula of Harris-Benedict which was calculated from the height, weight, age and sex. Nutritional status was also assessed by measuring various nutritional parameters in each patient on admission. The mean values of body weight, %IBW (ideal body weight), %AMC (arm muscle circumference as percentage of standard), %TSF (triceps skinfold as percentage of standard) and %GS (grip strength as standard) were significantly lower and REE higher in group 1 than in group 2. However those of TP, alb and BEE showed no significant difference. Negative correlations between REE and body weight, %AMC, and %GS were seen respectively, and a positive correlation between REE and BEE was also seen in group 1, although no significant correlation was seen in group 2. These results suggested that the energy requirement of anorexic patients should be estimated by measuring the REE in each individual to obtain an effective response.