Clinical Appraisal of the Additional Total Parenteral Nutrition Combined with Postoperative Enteral Feeding on the Patient of Thoracic Esophageal Cancer Surgery

Kiichi Aoki, Kenichiro IKeda and Nobuhiro Sato

Department of Surgery I, I wate Medical University

We conducted a prospective randomized clinical trial to determine whether additional total parenteral nutrition (TPN) after esophageal cancer surgery has better effect on amino acid metabolism and wound healing than enteral nutrition (EN) with and without TPN, EN alone (EN group), or EN+TPN (EN+TPN group). Twenty thoracic esophageal cancer patients who underwent total esophagectomy and reconstruction with a gastric tube and right thoraco-laparotomic cervical manipulation were preoperatively randomized to either the EN group (n=10) or the EN+TPN group (n=10). In both groups, EN was started at 5 kcal/kg (non-protein calories) on postoperative day (POD) 3 and was gradually increased to 30 kcal/kg/day on POD 8. In the EN group, 5% glucose in electrolyte solution was administered. In the EN+TPN group, TPN was started at a dose of 20kcal/kg/day on POD 1 and on the following days a total of over 30 kcal/kg/day was maintained by TPN plus EN. There were no significant differences between the two groups in regard to arteriovenous differences in plasma amino acids (branched-chain amino acids, glutamine, and alanine), total protein, albumin, rapid turnover proteins, factor XIII, prolyl hydroxylase, or fibronectin. In the EN+TPN group, blood urea nitrogen on PODs 5 and 7, and accumulated urinary nitrogen excretion were significantly higher than in the EN group. These results suggest that the additional TPN cannot prevent muscle breakdown and promote wound healing. The additional TPN combined with EN is unnecessary for postoperative thoracic esophageal cancer patients.

Key words
total parenteral nutrition, enteral nutrition amino acid, esophageal cancer, postoperative complication for the esophagus

Reprint requests
Kiichi Aoki Department of Surgery I, I wate Medical Omivorsity 19-1 Uchimaru, Morioka, 020-8505 JAPAN

Accepted
March 22, 2000

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