[Nutritional management of the patients after total gastrectomy using total parenteral nutrition (TPN)]

In this study therapeutic effect of total parenteral nutrition (TPN) for the patients undergoing total gastrectomy was evaluated and following results were obtained. Both incidence and cure rate of anastomotic leakage after total gastrectomy had markedly improved, in spite of increased resection rate and curative operation for the patients with advanced gastric cancer by introducing TPN routinely to the nutritional management. It is important to maintain serum albumin level above 3.0 g/dl to give enough calories and protein (40-50 kcal/kg/day). TPN using a combined carbohydrate solution such as the ratio for glucose, fructose, xylitol (4: 2: 1) seems to have a beneficial effect on the patients with surgical diabetes status. It is suggested that serum albumin is a most promising parameter in nutritional assessment of the preoperative period. But in the early postoperative period, rapid turnover protein such as prealbumin might be more accurate parameter. TPN during chemotherapy as an adjunct to surgery leads to diminished morbidity, and possibly to prolonged survival time in the patients undergoing gastrectomy for gastric cancer.