[Evaluation of the nutritional management of patients with liver cancer and cirrhosis].
Ninety-five patients with liver cancer and cirrhosis who had undergone hepatic lobectomy or partial hepatectomy were studied. According to nutritional protocol based on experimental results, a large quantity of fresh frozen plasma (FFP), and BCAA-enriched amino acids at 30 kcal/kg/d as an energy source were administered postoperatively for 7-10 days with strict restriction of sodium and total fluid volume. An elemental diet for liver dysfunction (ED-H) was given to 13 patients at more than 1,500 kcal/d via a naso-duodenal feeding tube for 7-14 days. Six patients were given 15 g/d of BCAA granules after discharge for as long as possible. Serum levels of TP, Alb, T.Bil and PT were kept moderately high in the IVH and ED-H group. Although BCAA/AAA molar ratio was kept high when IVH or ED-H was provided, it gradually fell if nutritional management was discontinued. This ratio was maintained within normal limits by oral administration of BCAA granules. According to the Child classification, 1,2,3 and 5-year cumulative survival rates were 80.9, 62.9, 44.1 and 25.5% for Child A, 70.0, 43.1, 43.1 and 0% for Child B, and 50.0, 25.0, 0 and 0% for Child C, respectively. These data indicate the importance of nutritional support for improvement of nutritional status and for obtaining a better prognosis. Oral BCAA supplementation should be useful for the performance of long-term nutritional management for cancer patients with liver cirrhosis.
Usui
S
S
Dept. of Surgery, Chiba University School of Medicine.
Sakamoto
A
A
Yamamoto
H
H
Yamamoto
Y
Y
Asano
T
T
Isono
K
K
D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage; D001803:Blood Transfusion; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D009747:Nutritional Physiological Phenomena; D010949:Plasma; D011182:Postoperative Care
D000597:Amino Acids, Branched-Chain