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

Abstract

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.

Energy Expenditure in Patients With Esophageal, Gastric, and Colorectal Cancer

“…When the influence of the perioperative time (preoperative or day 7 or 14 after the procedure) on the energy metabolism of these patients was evaluated, a significant increase in REE was observed on postoperative day 7. However, after 14 days, the values approached those recorded initially 31 . Our results also showed that the pre‐ and postoperative REE values were similar, suggesting that there was no interference of the surgical procedure with the results.…”

“…This finding demonstrates that closely matched controls were used in this work, as differences in relation to FFM 12 or weight and BMI 11 between cases and controls may result in differences concerning energy expenditure. Other authors have also suggested that the REE of patients and controls is similar 11 , 12 , 24 , 28 , 31 . However, Scott and colleagues (2001) evaluated patients with lung cancer and showed that the REE of patients was lower than that of controls 32 .…”

“…In relation to surgery, it has been suggested that the presence of a tumor and the time elapsed after the operation may influence energy expenditure, and it is believed that the effects of the tumor tend not to persist after resection 12 , 29 , 30 . Some patients in the current study had undergone surgical resection of the tumor, at an average of 56.3 days before the assessments were performed (a period that is presumed to be sufficient to normalize metabolism) 31 . Okamoto and colleagues (2011) evaluated 8 patients with operable esophageal cancer.…”

Nutritional Management of Esophageal Cancer Patients

“…The results showed that BEE of patients with squamous cell carcinoma was underestimated when using the HBE [62]. However, current evidence is inconsistent, since some studies suggest that REE is normal and is not affected by stage of disease [63][64][65]. Consequently, more research should be conducted in order to shed light on this controversial field.…”

Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later

“…REE can be unchanged, increased or decreased in relation to the predicted energy expenditure (18)(19)(20) . In about 25 % of patients with active cancer, REE measured by the gold standard method, indirect calorimetry, is more than 10 % higher, and in another 25 % it is more than 10 % lower than predicted energy expenditure (21) .…”