Resting energy expenditure in patients undergoing transhiatal or transthoracic oesophagectomy for carcinoma of the thoracic oesophagus

Sato, Nobuaki; Kusama, Akio; Ohkawa, Akira; Koyama, Yu; Oyamatsu, Manabu; Kayama, Seiji; Yoshikawa, Keiji; Tanaka, Otsuo; Muto, Terukazu

doi:10.1002/bjs.1800801119

Cited by 14 publications

(8 citation statements)

References 16 publications

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“…Sato et al (18,19) showed a 31% increase in the mREE in patients undergoing an esophagectomy. However, the increased rate in the mREE in our patients was lower than that from previous studies.…”

Section: Discussionmentioning

confidence: 97%

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Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

Okamoto

Sasaki

Johtatsu

et al. 2011

J. Clin. Biochem. Nutr.

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This study was to assess the resting energy expenditure of patients with esophageal cancer using indirect calorimetry. Eight male patients with esophageal cancer and eight male healthy controls were enrolled in this study. All patients underwent transthoracic esophagectomy with lymph nodes dissections. The resting energy expenditure was measured preoperatively, and on postoperative day 7 and 14 using indirect calorimetry. Preoperatively, the measured resting energy expenditure/body weight in these patients was significantly higher than that of the controls (23.3 ± 2.1 kcal/kg/day vs 20.4 ± 1.6 kcal/kg/day), whereas the measured/predicted energy expenditure from the Harris-Benedict equation ratio was 1.01 ± 0.09, which did not differ significantly from the control values. The measured resting energy expenditure/body weight was 27.3 ± 3.5 kcal/kg/day on postoperative day 7, and 23.7 ± 5.07 kcal/kg/day on postoperative day 14. Significant increases in the measured resting energy expenditure were observed on postoperative day 7, and the measured/predicted energy expenditure ratio was 1.17 ± 0.15. In conclusion, patients with operable esophageal cancers were almost normometabolic before surgery. On the other hand, the patients showed a hyper-metabolic status after esophagectomy. We recommended that nutritional management based on 33 kcal/body weight/day (calculated by the measured resting energy expenditure × active factor 1.2–1.3) may be optimal for patients undergoing esophagectomy.

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Section: Discussionmentioning

confidence: 97%

“…(20) Although one would be more likely to find stress-induced hypermetabolism on earlier postoperative days, the increase in the mREE of patients undergoing a transhiatal or transthoracic esophagectomy was almost the same as during the first seven days. (18) …”

Section: Discussionmentioning

confidence: 99%

Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

Okamoto

Sasaki

Johtatsu

et al. 2011

J. Clin. Biochem. Nutr.

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“…Limiting surgical stress for patients with significant medical comorbidity is clearly desirable. Indeed it has been shown that energy expenditure is significantly lower following TH when compared to TT, 24 although this may arguably be a function of the shorter operating time necessary for a TH approach.…”

Section: Discussionmentioning

confidence: 99%

Prospective comparison of transthoracic versus transhiatal esophagectomy following neoadjuvant therapy for esophageal cancer

Morgan¹,

Lewis²,

Hopper³

et al. 2007

Diseases of the Esophagus

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Transthoracic esophagectomy (TT) has been championed as a better cancer operation than transhiatal esophagectomy (TH) because the approach facilitates meticulous wide tumor excision and lymphadenectomy. However, neoadjuvant chemoradiotherapy (CRTS) and chemotherapy (CS) have been reported to improve outcomes, and we aimed to compare outcomes after multimodal therapy related to the operative approach. One hundred and fifty-one consecutive patients were studied prospectively. All patients were staged with computed tomography and endoluminal ultrasound, and treatment decisions were related to stage and performance status. One hundred and nineteen TT (median age 58 years, 92 male, 54 CRTS, 65 CS) were performed compared to 32 TH (median age 57 year, 27 male, 14 CRTS, 18 CS). Primary outcome measure was survival. Post-operative morbidity and mortality were 54% and 4%, respectively, after TT compared with 59% and 6% after TH (chi2 0.239 df 1, P=0.625). Recurrent cancer was no less frequent after TT (52%) than after TH (37.5%, chi2 2.151 df=1, P=0.142). Cumulative uncorrected 5-year survival was 34% after TT compared with 53% after TH (log rank 1.44, df=1, P=0.2298). Median survival was also similar in lymph node positive patients (TT vs. TH, 23 months vs. 22 months, respectively, log rank 0.25, df=1, P=0.6199). Despite the fact that patients receiving multimodal therapy and a TH esophagectomy were less fit, operative morbidity, mortality and recurrence were similar, and survival did not differ significantly when compared with multimodal TT esophagectomy.

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“…Furthermore, several operative procedures, such as esophagectomy via transhiatal, right and left thoracotomy, have also been included in these study populations, although surgical stress and the rate of postoperative morbidity and mortality differ between the transthoracic approach with one‐lung ventilation and the transhiatal approach …”

Section: Introductionmentioning

confidence: 99%

Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

et al. 2014

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We compared the surgical outcomes between 114 patients who did not receive neoadjuvant therapy (group 1) and 92 others who received neoadjuvant chemoradiotherapy (nCRT) (group 2), and assessed the preoperative and surgical factors that influence postoperative morbidity to determine the impact of nCRT on morbidity and mortality after esophagectomy via cervical, right transthoracic, and abdominal approaches. The overall postoperative morbidity rates were 44.7% and 55.4% in groups 1 and 2, respectively (P = 0.13). Rates of anastomotic leak (8.8% vs. 16.3%; P = 0.10), pneumonia (9.6% vs. 13.0%; P = 0.44), recurrent nerve palsy (15.8% vs. 10.9%; P = 0.31), and all other complications did not significantly differ between the groups. Multivariable analysis revealed cervical lymph node dissection (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01-3.84; P = 0.047) as the sole independent covariate for overall morbidity. Furthermore, a history of cardiovascular disease (OR, 2.90; 95% CI, 1.03-8.24; P = 0.045), the retrosternal reconstruction route (OR, 15.15; 95% CI, 3.56-62.50; P = 0.0002), and a longer surgical duration (OR, 1.01; 95% CI, 1.002-1.02; P = 0.01) were independent covariates for anastomotic leakage, and advanced age (OR, 1.08; 95% CI, 1.01-1.15; P = 0.02) and lower body mass index (OR, 1.16; 95% CI, 1.01-1.33; P = 0.04) were independent covariates for pneumonia. However, whether or not patients received nCRT was irrelevant. We found that nCRT is safe for three-incision esophagectomy and it does not increase the incidence of postoperative morbidity and mortality relative to esophagectomy alone.

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Resting energy expenditure in patients undergoing transhiatal or transthoracic oesophagectomy for carcinoma of the thoracic oesophagus

Cited by 14 publications

References 16 publications

Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

Prospective comparison of transthoracic versus transhiatal esophagectomy following neoadjuvant therapy for esophageal cancer

Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

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