Document Detail

Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma.
MedLine Citation:
PMID:  9486779     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. METHODS: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-alpha and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. RESULTS: All the parameters in nutritional assessment declined profoundly by the third postoperative day (P < 0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (> 1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P < 0.05), but immunoglobulins and complements decreased significantly yet variably (P < 0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P < 0.05). CONCLUSIONS: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.
L S Wang; H Y Lin; C J Chang; H J Fahn; M H Huang; C F Lin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of surgical oncology     Volume:  67     ISSN:  0022-4790     ISO Abbreviation:  J Surg Oncol     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-03-11     Completed Date:  1998-03-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0222643     Medline TA:  J Surg Oncol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  90-8     Citation Subset:  IM    
Department of Surgery, Veterans General Hospital and National Yang-Ming Medical University, Taipei, Taiwan, Republic of China.
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MeSH Terms
Antigens, CD / blood
Carcinoma, Squamous Cell / blood,  immunology*,  surgery
Cholesterol / blood
Esophageal Neoplasms / blood,  immunology*,  surgery
Esophagectomy* / methods
Iron / blood
Lymphocyte Subsets
Middle Aged
Nutritional Status*
Prospective Studies
Serum Albumin / analysis
Trace Elements / blood
Transferrin / analysis
Reg. No./Substance:
0/Antigens, CD; 0/Serum Albumin; 0/Trace Elements; 11096-37-0/Transferrin; 57-88-5/Cholesterol; 7439-89-6/Iron

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