Skip to main content

Advertisement

SpringerLink
Log in

Optimal dose of preoperative enteral immunonutrition for patients with esophageal cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

This study suggests that 500 ml of IMPACT is recommended as an optimal dose for patients with esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of oesophageal carcinoma. Br J Surg 1990;77:845–857.

    Article  PubMed  CAS  Google Scholar 

  2. Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 1995;222:654–662.

    Article  PubMed  CAS  Google Scholar 

  3. Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thorac Surg 2002;73:922–926.

    Article  PubMed  Google Scholar 

  4. Fang W, Kato H, Tachimori Y, Igaki H, Sato H, Daiko H. Analysis of pulmonary complications after tree-field lymph node dissection for esophageal cancer. Ann Thorac Surg 2003;76:903–908.

    Article  PubMed  Google Scholar 

  5. Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg 2001;233:338–344.

    Article  PubMed  CAS  Google Scholar 

  6. Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004;240:791–800.

    Article  PubMed  Google Scholar 

  7. Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg 2008;393:127–133.

    Article  PubMed  Google Scholar 

  8. Shichinohe T, Hirano S, Kondo S. Video-assisted esophagectomy for esophageal cancer. Surg Today 2008;38:206–213.

    Article  PubMed  Google Scholar 

  9. Braga M, Gianotti L, Gentilini O, Parisi V, Salis C, Di Carlo V. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med 2001;29:242–248.

    Article  PubMed  CAS  Google Scholar 

  10. Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomized multicenter trial. Lancet 2001;358:1487–1492.

    Article  PubMed  CAS  Google Scholar 

  11. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, et al. Enteral versus parenteral feeding: effect on septic morbidity after blunt and penetrating trauma. Ann Surg 1992;215:503–511.

    Article  PubMed  CAS  Google Scholar 

  12. Kemen M, Senkal M, Homann HH, Mumme A, Dauphin AK, Baier J, et al. Early postoperative enteral nutrition with arginine, omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact. Crit Care Med 1995;23:652–659.

    Article  PubMed  CAS  Google Scholar 

  13. Senkal M, Kemen M, Homann HH, Eickhoff U, Baier J, Zumtobel V. Modulation of postoperative immune response by enteral nutrition with a diet enriched with arginine, RNA, and omega-3 fatty acids in patients with upper gastrointestinal cancer. Eur J Surg 1995;161:115–122.

    PubMed  CAS  Google Scholar 

  14. Hall JC, Heel K, McCauley R. Glutamine. Br J Surg 1996;83:305–312.

    Article  PubMed  CAS  Google Scholar 

  15. Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Di Carlo V. Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg 1996;162:105–112.

    PubMed  CAS  Google Scholar 

  16. Daly JM, Lieberman MD, Goldfine J, Shou J, Weintraub F, Rosato EF, et al. Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic and clinical outcome. Surgery 1992;112:56–67.

    PubMed  CAS  Google Scholar 

  17. Van der Hulst RRW, Van Kreel BK, Von Meyenfeld MF, Brummer RJ. Glutamine and the prevention of gut integrity. Lancet 1993;341:1363–1365.

    Article  PubMed  Google Scholar 

  18. Braga M, Gianotti L, Radaelli G, Vignali A, Mari G, Gentilini O, et al. Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg 1999;134:428–433.

    Article  PubMed  CAS  Google Scholar 

  19. Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg 1999;134:1309–1316.

    Article  PubMed  CAS  Google Scholar 

  20. Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer. Surgery 2002;132:805–814.

    Article  PubMed  Google Scholar 

  21. Xu J, Zhong Y, Jing D, Wu Z. Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer. World J Surg 2006;30:1284–1289.

    Article  PubMed  Google Scholar 

  22. Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer. A meta-analysis of randomized controlled clinical trials. Ann Surg 1999;229:467–477.

    Article  PubMed  CAS  Google Scholar 

  23. Sato N, Koeda K, Ikeda K, Kimura Y, Aoki K, Iwaya T, et al. Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg 2002;236:184–190.

    Article  PubMed  Google Scholar 

  24. Atkinson S, Sieffert E, Bihari D. A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy’s Hospital Intensive Care Group. Crit Care Med 1998;26:1164–1172.

    Article  PubMed  CAS  Google Scholar 

  25. Gianotti L, Braga M, Gentilini O, Balzano G, Zerbi A, Di Carlo V. Artificial nutrition after pancreaticoduodenectomy. Pancreas 2000;21:344–351.

    Article  PubMed  CAS  Google Scholar 

  26. Takeuchi H, Ikeuchi S, Kawaguchi Y, Kitagawa Y, Isobe Y, Kubochi K, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg 2007;31:2160–2167.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Masaki Nakamura, Makoto Iwahashi, Katsunari Takifuji, Mikihito Nakamori, Teiji Naka, Koichiro Ishida, Toshiyasu Ojima, Takeshi Iida, Masahiro Katsuda, Keiji Hayata & Hiroki Yamaue

Authors
  1. Masaki Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Iwahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsunari Takifuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mikihito Nakamori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teiji Naka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichiro Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshiyasu Ojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masahiro Katsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keiji Hayata
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroki Yamaue
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakamura, M., Iwahashi, M., Takifuji, K. et al. Optimal dose of preoperative enteral immunonutrition for patients with esophageal cancer. Surg Today 39, 855–860 (2009). https://doi.org/10.1007/s00595-009-3967-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-009-3967-z

Key words

Search

Navigation