Perioperative Nutritional Support For Older Esophagectomy Patients

Background and objective:China has experienced a rapid growth in the incidence of esophageal cancer, aging is an important contributing factor, so incidence rate of esophageal cancer is increased year by year. Treatment modalities for esophageal carcinoma are almost the same for years, but surgical removal is still the mainstay treatment option. By the improvement of living standards and health care conditions, many elderly patients has undergone esophagectomies. In general, most esophageal cancer patients suffered from dysphagia which would cause severe malnutrition, aggressive tumor growth and postoperative gastrointestinal decompression may induce nutritional imbalance for such patients. So we reviewed published papers about early nutritional support for esophageal cancer patients, but papers about early enteral nutrition for esophageal cancer patients are few. The aims of our study were as follows:1. It can be a useful tool for evaluating nutritional status of the patient.2. When and how we can reduce posropertaive mortality and morbidity.3. We also discuss better solutions for such conditions.Materials and Methods:Medical records from113consecutive elderly patients undergoing esophagectomy were analyzed from Jan.2006to Dec.2010at Dept. of Thoracic Surgery, Zhejiang Hospital. NSR-2002and NRI were used to evaluate risk factors. According to the NRL results, they were divided into four subgroups. Group1(n=16), TPN is administered for non malnutrition patients. Group2(n=27) TPN is administered for mild malnutrition patients. Groups3(n=25), EN+PN are administered for non malnutrition patients. Group4(n=45), EN is administered orally5-7days preoperatively, EN+PN are administered postoperatively. Patient’s body weight, serum albumin and lymphocytes are detected, recovery of gastrointestinal functions and postoperative mortality are observed.Result:Most of elderly people had experienced a certain degree of malnutrition, the comparison between two types of evaluating tool showed almost all the elderly patients had severe nutritional risk according to the NRS-2002, and NRI is a better indicator of preoperative nutritional status. Comparison between two nutritional pathway showed that recovery of gastrointestinal functions of group EN is earlier than group TPN, preoperative improvement of nutritional status of the patients who suffer from malnutrition preoperatively had a statistical significance,and it can reduce postoperative complications. When elderly patients received EN pathway, if they had abdominal distention, diarrhea, the dose of EN should be reduced. Heating and slowing down the speed of dripping can reduce such nutrition-related symptoms. Parenteral nutrition can be an alternative if energy is still not enough.Conclusion:1. Almost all elderly patients had a certain degree of malnutrition, preoperative evaluation of nutritional status by NRI had a more real significance.2. For patients who suffered from malnutrition, preoperative improvement of nutritional status plays important role in improving the nutritional status and immunity of the patients.3. Postoperative EN has greater importance tan TPN which can accelerate the recovery of gastrointestinal functions, and decease infections.4. Elderly patients had a high risk of nutrition-related symptoms such as abdominal distention and diarrhea. But heating and slowing down the speed of dripping can reduce such symptoms. If the symptoms are still persistent, parenteral nutrition can be a compensation.