Der postoperative Energiebedarf nach gro�en abdominal-chirurgischen Eingriffen: Vergleich der Messung durch indirekte Calorimetrie mit rechnerischer Sch�tzung

Brandmair, W.; Lehr, L.

doi:10.1007/bf01261723

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Because no difference according to tumor stage can be seen, these perioperative changes have to be attributed to the surgical trauma itself. Brandmair and Lehr [17] showed that the trauma in major abdominal surgery leads to an increase of fat oxidation which can be also observed in our series. Further more.…”

Section: Discussionsupporting

confidence: 70%

Perioperative Changes in Body Composition and Metabolism in Patients with Colorectal Cancer according to Tumor Stage

Weirnann¹,

Raab²,

Selberg³

et al. 1996

Oncol Res Treat

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Background: Reports about the influence of curative and palliative tumor resection on metabolism and resting energy expenditure (REE) in colorectal carcinoma are controversial. This study deals with a group of patients with colorectal cancer of all tumor stages undergoing surgery for the primary. Special attention was attributed to the question whether perioperative changes of REE and body composition depend on tumor stage. Patients and Methods: In a prospective study 32 colorectal cancer patients undergoing surgery were investigated in order to compare nutritional status, body composition and metabolism according to tumor stage. In 18 patients with UICC tumor stages I-III the tumors could be completely removed and in 14 patients with stage IV there was persisting tumor mass as liver metastases after resection of the primary. 10 days pre- and post-operatively bioelectrical body impedance analysis (B.I.A.), indirect calori-metry as well as serum and urine analysis were performed. Results: According to tumor stages no significant inter-group difference was observed in body mass index and preoperative weight loss. Significant increase of extracellular/body cell mass ratio indicating an increase of extracellular mass and decrease of body cell mass was preoperatively found in patients with metastatic colorectal cancer. Correlation between the percentage of preoperative weight loss and extracellular/body cell mass ratio was found in patients with tumor stages I-III. Preoperatively, resting energy expenditure, substrate oxidation rates, serum albumin and trans-ferrin as well as urine 3-methylhistidine excretion were without significant differences between the two groups. After resection of the primary no shift towards hypermetabolism was found in patients with unresected metastases compared to those with complete tumor removal. Taking into account the effects of the surgical trauma itself, postoperatively a further increase of extracellular mass and decrease of body cell mass was observed. These changes led to significantly higher ratios of extracellular/body cell mass and resting energy expenditure/body cell mass in patients with metastatic disease. Resting energy expenditure, substrate oxidation rates, serum albumin and transferrin and urine 3-methylhistidine excretion did not reveal significant inter-group differences postoperatively. Conclusion: No difference in body mass index, resting energy expenditure, protein oxidation and 3-methylhistidine urinary excretion can be found in patients with colorectal cancer without and with liver metastases before and after resection of the primary. However, there are indicators for a perioperative higher decrease of body cell mass in patients with liver metastases and palliative resection of the primary. This might be partially attributed to peripheral protein mobilization and protein retention and synthesis by the tumor itself.

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Section: Discussionsupporting

confidence: 70%

Perioperative Changes in Body Composition and Metabolism in Patients with Colorectal Cancer according to Tumor Stage

Weirnann¹,

Raab²,

Selberg³

et al. 1996

Oncol Res Treat

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“…Dies best/itigt die Ergebnisse von Brandmair u. Lehr [5] und Hansell et al [9]. Lindmark et al [15] zeigten bereits im friihen Stadium der Malnutrition bei Karzinompatienten einen gesteigerten Ruheenergiebedarf, wobei die Erh6hung lediglich 12% im Vergleich zu unterern/ihrten Patienten ohne Tumor betrug.…”

Section: Postoperative Kornplikationenunclassified

“…Gleichzeitig war die Proteinoxidation bei gehemmter Glukoseoxidation gering erh6ht (Gruppe I u n d III) oder sogar vermindert (Gruppe II). Ebenso zeigen diese Ergebnisse, wie von Brandmair u. Lehr [5] belegt, daB der postoperativ erh6hte Energiebedarf prim/Jr zur Steigerung der Fettoxidation ffihrt. Die perioperativen Ver/inderungen sind am ausgeprfigtesten bei den Patienten in relativ gutem Ern/ihrungsstatus.…”

Section: Perioperative Adaptationunclassified

Bedeutung des pr�operativen Gewichtsverlusts f�r die perioperative Stoffwechseladaptation und das Operationsrisiko bei Patienten mit Tumoren im oberen Gastrointestinaltrakt

Weimann¹,

Meyer²,

Müller³

et al. 1992

Langenbecks Arch Chir

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Body composition and energy expenditure were investigated before and 10-14 days after surgery in 44 patients with upper gastrointestinal cancer (23 esophageal and 21 gastric cancer) in order to assess the impact of preoperative weight loss on metabolic adaptation to the surgical trauma and on postoperative complications. Patients were divided in three groups with I: 0-5%, II: 5-10% and III: greater than 10% preoperative weight loss related to the usual body weight. 50% of the patients presented with no or just minor weight loss. Even in case of weight loss greater than 10% no decrease below the ideal body weight was observed. Body cell mass and fat mass were significantly (p less than 0.05) reduced in group III when compared with I. Since energy expenditure and substrate oxidation rates were rather normal in most patients weight loss was considered to be due to tumor related stenosis and dysphagia. More than 50% of the energy requirements were gained from fat oxidation. General criteria of malnutrition were not fulfilled. Perioperative weight loss was lowest (1.6 +/- 4.9 kg) in patients of group III related to group I (2.9 +/- 1.7 kg) and II (5.0 +/- 6.9 kg). Similar elevation of energy expenditure and lipid oxidation with concomitant reduction in glucose oxidation was observed in all groups of patients. This led to a similar decrease of body cell mass. Independent of preoperative weight loss major complications occurred in 8 cases--pneumonia in 6 and leakage of the anastomosis in 2 patients; no patient died. From this study can be concluded that with regard to perioperative weight loss the metabolic response to surgical trauma is adequate even in patients with marked preoperative weight loss. These patients remain compensated and preoperative weight loss is without major effect on postoperative complication rate.

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Effect of liver disease and transplantation on urea synthesis in humans: relationship to acid-base status

Shangraw

Jahoor

1999

American Journal of Physiology-Gastrointestinal and Liver Physi

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It has been suggested that hepatic urea synthesis, which consumes[Formula: see text], plays an important role in acid-base homeostasis. This study measured urea synthesis rate (Ra urea) directly to assess its role in determining the acid-base status in patients with end-stage cirrhosis and after orthotopic liver transplantation (OLT). Cirrhotic patients were studied before surgery ( n = 7) and on the second postoperative day ( n = 11), using a 5-h primed-constant infusion of [15N2]urea. Six healthy volunteers served as controls. Ra urea was 5.05 ± 0.40 (SE) and 3.11 ± 0.51 μmol ⋅ kg−1 ⋅ min−1, respectively, in controls and patients with cirrhosis ( P < 0.05). Arterial base excess was 0.6 ± 0.3 meq/l in controls and −1.1 ± 1.3 meq/l in cirrhotic patients (not different). After OLT, Ra urea was 15.05 ± 1.73 μmol ⋅ kg−1 ⋅ min−1, which accompanied an arterial base excess of 7.0 ± 0.3 meq/l ( P < 0.001). We conclude that impaired Ra urea in cirrhotic patients does not produce metabolic alkalosis. Concurrent postoperative metabolic alkalosis and increased Ra urea indicate that the alkalosis is not caused by impaired Ra urea. It is consistent with, but does not prove, the concept that the graft liver responds to metabolic alkalosis by augmenting Ra urea, thus increasing[Formula: see text] consumption and moderating the severity of metabolic alkalosis produced elsewhere.

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Der postoperative Energiebedarf nach gro�en abdominal-chirurgischen Eingriffen: Vergleich der Messung durch indirekte Calorimetrie mit rechnerischer Sch�tzung

Cited by 3 publications

References 16 publications

Perioperative Changes in Body Composition and Metabolism in Patients with Colorectal Cancer according to Tumor Stage

Perioperative Changes in Body Composition and Metabolism in Patients with Colorectal Cancer according to Tumor Stage

Bedeutung des pr�operativen Gewichtsverlusts f�r die perioperative Stoffwechseladaptation und das Operationsrisiko bei Patienten mit Tumoren im oberen Gastrointestinaltrakt

Effect of liver disease and transplantation on urea synthesis in humans: relationship to acid-base status

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