Comparative study of nutritional managements for postoperative esophageal cancer patients - Enteral nutrition alone vs EN + TPN-

In order to determine the efficacy of total parenteral nutrition (TPN) as the postoperative nutritional mangement for thoracic esophageal cancer patients, we conducted a prospective randomized clinical trial, comparing enteral nutrition (EN) with and without TPN, EN alone and EN + TPN. Twenty-two patients who underwent total esophagectomy and reconstruction using a gastric tube with right thoracolaparotomic cervical manipulation were preoperatively randomized to either the EN alone group (n = 10) or the EN + TPN group (n= 12). In both groups, EN was started on the 3rd postoperative day (POD) at an initial dose of 5 kcal/kg/day (non-protein calories) and was gradually increased to a full strength of over 30 kcal/kg/day on POD 8 through jejunostomy. In the EN alone group, intravenous infusion of which the content was similar to that of extracellular fluid was administered peripherally. In the EN + TPN group, TPN was started at a dose of 20 kcal/kg/day on POD 1 and on the following days a total of over 30 kcal/kg/day was maintained by TPN plus EN. Nitrogen balance, nutritional parameters, liver function, postoperative complications and medical expenses were evaluated. In the EN alone group, nitrogen balance became positive on POD 10. On the other hand, in the EN + TPN group, it was positive on 3rd and 9th POD, indicating a biphasic curve. In the changes in total protein, albumin, rapid turnover proteins and 3-methyl histidine, no statistically significant differences between the two groups were observed. However, the levels of blood urea nitrogen. GOT and triglyceride in the EN + TPN group were significantly higher than those in the EN alone group. Cost saving was achieved in the EN alone group. These results suggest that TPN is not absolutely necessary for the postoperative nutritional management of thoracic esophageal cancer patients, if EN can be started on the 3rd POD.