Postoperative Management of Infusion and Nutrition for Thoracic Esophageal Cancer Patients

Kenichiro Ikeda, Nobuhiro Sato, Keisuke Koeda, Eiji Meguro, Noriyuki Uesugi, Satoshi Ogasawara, Kouki Otsuka, Yusuke Kimura, Chihaya Maesawa*, Yasunori Yaegashi, Masanori Terashima, Kazumi Okamoto, Kaoru Ishida, Kazuyoshi Saito

Department of Surgery 1, Iwate Medical University
*Department of Pathology, Division of Clinical Research Morioka National Hospital

Out of 38 patients who were underwent total thoracic esophagectomy under thoracolaparotomic cervical manipulation, 14 patients were assessed as to water and electrolyte metabolism and nutritional parameters, and all of them were studied about the postoperative complications under our postoperative infusion and nutritional management as follows: 1) In order to maintain stable circulation during the perioperative period, the infusion volume, whose contents were similar to extracellular fluid, was determined by the value of the preoperative cardiac index and end diastolic volume index 2) The nutrition was given by enteral feeding without TPN at the introducing dose of 5 kcal/kg/day from 3 postoperative day (POD) and gradually increased at a full dose of 30 kcal/kg/day. Total water and sodium intake on the operation day just after surgery were significantly higher than those on other postoperative days, 5.24 ml/kg/hr and 0.56 mEq/kg/hr, respectively. Total calorie intake reached 30 kcal/kg/day on 9 POD. Nitrogen and potassium balances became positive on 10 and 4 POD, respectively. Total protein, albumin, prealbumin, transferrin, retinol binding protein and peripheral lymphocyte counts were the lowest on 3 POD. 3-methylhistidine urinary excretion and C-reactive protein were the highest on 3 POD. All these parameters returned to the preoperative values on 14 POD. The incidences of postoperative complications were 11% of primary pulmonary complication, 8% of arrhythmia, 11% of hyperbilirubinemia, 3% of minor leakage and 3% of ileus, respectively. These results suggest that our postoperative management is simple and safety mothod against thoracic esophageal cancer surgery.

Key words
postoperative management for esophageal cancer, enteral nutrition, infusion therapy, postoperative complication of esophageal cancer

Reprint requests
Kenichiro Ikeda Department of Surgery 1, Iwate Medical University
19-1 Uchimaru, Morioka, 020 JAPAN

Accepted
March 8, 1995

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