Abstract
In order to clarify a possible contribution of preoperative nutritional state to inducing and/or worsening lung complication in patients operated on for esophageal cancer, 35 patients with the cancer were subjected to a study of preoperative nutritional state and hemodynamic changes on exercise tests using Swan-Ganz catheter. The 35 patients were divived into two groups. Group 1 (n=17): preoperative daily calorie intake was less than 1.75×BEE (basal energy expenditure), and Group 2 (n=18): more than 1.75×BEE. There were singnificant differences between Group 1 and 2 in preoperative daily calorie intake, rapid turnover protein and total lymphocyte counts. Analysis of preoperative hemodynamic changes on exercise tests revealed that the cardiac function was better in Group 2 than in Group 1. Lung complications occurred in 47% in Group 1 and 17% in Group 2.
In another 32 patients, biopsies from diaphragm were taken during operation. The specimens were stained for histochemical reaction by myosin ATPase, divided into type 1 (slow muslce) and type II (fast muscle) muscle fibers, and measured the size and distribution of the types. Muscle fiber area of diaphragm were correlate with anthropometrical indexes, and so nutritionally depleted cases had smaller muscle fiber sizes. Area occupation ratio of diaphragm was lineally related to serum proteins, total cholesterol and prognostic nutritional index and type II fibers were dominant in malnourished patients. It means that malnutritional diaphragm was more fatigable than well nutritional one. In the patients whose muscle proportional area of diaphragm of type I was under 50% (n=17), the incidence of lung complications was significantly (p<0.02) higher than those (n=15) having the type I by over 50%.
