Postoperative Management of Infusion and Nutrition for Thoracic Esophageal Cancer Patients

Out of 38 patients who were underwent total thoracic esophagectomy under thoracolaparotomic cervical manipulation, 14 patients were assessed as to water and electrolyte metabolism and nutritional parameters, and all of them were studied about the postoperative complications under our postoperative infusion and nutritional management as follows: 1) In order to maintain stable circulation during the perioperative period, the infusion volume, whose contents were similar to extracellular fluid, was determined by the value of the preoperative cardiac index and end diastolic volume index 2) The nutrition was given by enteral feeding without TPN at the introducing dose of 5 kcal/kg/day from 3 postoperative day (POD) and gradually increased at a full dose of 30 kcal/kg/day. Total water and sodium intake on the operation day just after surgery were significantly higher than those on other postoperative days, 5.24 ml/kg/hr and 0.56 mEq/kg/hr, respectively. Total calorie intake reached 30 kcal/kg/day on 9 POD. Nitrogen and potassium balances became positive on 10 and 4 POD, respectively. Total protein, albumin, prealbumin, transferrin, retinol binding protein and peripheral lymphocyte counts were the lowest on 3 POD. 3-methylhistidine urinary excretion and Creactive protein were the highest on 3POD. All these parameters returned to the preoperative values on 14 POD. The incidences of postoperative complications were 11% of primary pulmonary complication, 8% of arrhythmia, 11% of hyperbilirubinemia, 3% of minor leakage and 3% of ileus, respectively. These results suggest that our postoperative management is simpleand safety mothod against thoracic esophageal cancer surgery.