Energy requirement after major abdominal operations, as calculated according to the formula for basic energy expenditure by Harris-Benedict, was increased by 30% in the early and by 50% in the late postoperative period. Correlation of these calculated values to measurements by indirect calorimetry was good. Even more simply a good estimation of caloric requirements can be obtained by multiplication of the body weight with a factor 30. The development of septic complications does not increase considerably postoperative energy expenditure, however, the correlation between measured and estimated values becomes poor. As supposed from isotope studies measuring gas exchange for indirect calorimetry for one hour provides sufficiently stable results.

In a prospective study including 60 patients with esophageal carcinoma the nutritional status was evaluated by means of anthropometric, biochemical and immunological data. As a first measure of malnutrition the diminuation of each single parameter was estimated in a 10%-scale, according to this a linear rising number of points given and the sum for all 11 parameters expressed as a score (Gofferje and Fekl). Second the nutritional status was judged by the prognostic nutritional index (Buzby and Mullen). Both score and index were correlated with serious postoperative complications (wound infection, anastomotic leakage, sepsis, organ failure, death). The results show that it was not possible to assess the risk of esophagectomy preoperatively on the ground of nutritional parameters solely. The reason could be that the nutritional status was rather normal in most cases and its risk burden therefore low. In conclusion performing preoperative nutritional therapy routinely seems not to be justified.

No abstract