Abstract
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 heal-ing 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 turn-over 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 heal-ing. The additional TPN combined with EN is unnecessary for postoperative thoracic esophageal cancer patients.
