Optimal dose of preoperative enteral immunonutrition for patients with esophageal cancer

Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Surgery Today (Impact Factor: 1.53). 10/2009; 39(10):855-60. DOI: 10.1007/s00595-009-3967-z
Source: PubMed


A preoperative immunonutrition pharmaceutics diet (IMPACT) significantly reduced the incidence of postoperative infectious complications, but the optimal regimen still remains unclear. We evaluated the optimal dose of a preoperative IMPACT for patients with esophageal carcinoma and the incidence of postoperative complications based on the dose of IMPACT.
This study design was a prospective nonrandomized study. Twenty patients with thoracic esophageal carcinoma who underwent a right transthoracic subtotal esophagectomy were divided into two groups. These patients were administered immunonutrition of 500 ml/day (IMP500) or 1000 ml/day (IMP1000) for 7 days before the operation.
The incidence of postoperative mortality and morbidity was not different between the IMP500 group and the IMP1000 group. No difference was observed in the perioperative changes in inflammatory, immunological and nutritional variables between the two groups. There were no adverse effects in the IMP500 group, but four patients (40%) had diarrhea and four patients (40%) had appetite loss in the IMP1000 group. In the IMP1000 group, only four patients (40%) could take 1000 ml, but others reduced the quantity of IMPACT because of diarrhea and discomfort.
This study suggests that 500 ml of IMPACT is recommended as an optimal dose for patients with esophageal cancer.

1 Follower
17 Reads
  • Source
    • "The ESPEN and SCCM/ASPEN guidelines support the use of immune enhancing diets in elective surgery patients during the preoperative period.(26,27) Immunonutrition has also been shown to be beneficial in subsets of Japanese patients undergoing esophagectomy.(28,29) In our study, the patients were given 750 kcal/day of IMPACT in addition to a conventional diet for 5 days before the operation, and all patients maintained oral nutrition satisfactorily. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was to assess the resting energy expenditure of patients with esophageal cancer using indirect calorimetry. Eight male patients with esophageal cancer and eight male healthy controls were enrolled in this study. All patients underwent transthoracic esophagectomy with lymph nodes dissections. The resting energy expenditure was measured preoperatively, and on postoperative day 7 and 14 using indirect calorimetry. Preoperatively, the measured resting energy expenditure/body weight in these patients was significantly higher than that of the controls (23.3 ± 2.1 kcal/kg/day vs 20.4 ± 1.6 kcal/kg/day), whereas the measured/predicted energy expenditure from the Harris-Benedict equation ratio was 1.01 ± 0.09, which did not differ significantly from the control values. The measured resting energy expenditure/body weight was 27.3 ± 3.5 kcal/kg/day on postoperative day 7, and 23.7 ± 5.07 kcal/kg/day on postoperative day 14. Significant increases in the measured resting energy expenditure were observed on postoperative day 7, and the measured/predicted energy expenditure ratio was 1.17 ± 0.15. In conclusion, patients with operable esophageal cancers were almost normometabolic before surgery. On the other hand, the patients showed a hyper-metabolic status after esophagectomy. We recommended that nutritional management based on 33 kcal/body weight/day (calculated by the measured resting energy expenditure × active factor 1.2-1.3) may be optimal for patients undergoing esophagectomy.
    Journal of Clinical Biochemistry and Nutrition 11/2011; 49(3):169-73. DOI:10.3164/jcbn.11-13 · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A novel technique is developed for efficient finite-element solution of open-region three-dimensional transmission line structures in the quasi-TEM (transverse electromagnetic) regime. Starting with the general form of the solution to the three-dimensional Laplace equation in spherical coordinates, a set of asymptotic boundary condition (ABC) operators is derived. The second-order ABC is then applied on a conformable outer boundary for the purpose of truncating the finite-element method (FEM) mesh in an efficient manner. To illustrate its application, the method is used to compute the capacitance of a rectangular microstrip patch and the results are found to be in good agreement with published data
  • [Show abstract] [Hide abstract]
    ABSTRACT: An efficient coding method using a three-dimensional discrete cosine transform (DCT) for still images is presented. This is an extended version of the traditional DCT coding method. The adaptive application of the three-dimensional DCT to each sub-block makes the coding more efficient than the other DCT methods
Show more