title: Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery.
abstract: OBJECTIVE
  We have previously reported the beneficial effects of immediate enteral nutrition (EN) after esophageal cancer surgery. This randomized control study was conducted to determine whether immediate EN is beneficial or not for patients whose thoracic ducts were ligated, as well as those whose thoracic ducts were preserved.
  
  
  METHODS
  Thirty-nine patients who underwent radical resection of the esophageal cancer entered this trial. After stratifying into two groups--patients whose thoracic ducts were preserved [D(+)] and those whose thoracic ducts were ligated [D(-)], they were randomly divided into two groups--the patients who received early EN and those who received parenteral nutrition (PN) followed by delayed enteral feeding. Thus, the number of patients in the D(+)-EN group, D(+)-PN group, D(-)-EN group and D(-)-PN group were 13, 12, 7 and 7, respectively. The mortality and morbidity rates, and several blood chemistries were compared between the EN groups and the PN groups.
  
  
  RESULTS
  Total lymphocyte count showed a significant early increase and serum c-reactive protein (CRP) was significantly decreased in the D(+)-EN group compared to the D(+)-PN group. However those differences were not observed between the D(-) groups. Serum total bilirubin was significantly decreased in the both EN groups compared to the PN groups. The mortality and morbidity rates were not different between the EN group and the PN group in the D(+) patients and also in the D(-) patients.
  
  
  CONCLUSIONS
  Patients whose thoracic ducts were ligated did not obtain any other benefit from early enteral feeding except for bilirubin metabolism. Early enteral feeding is not recommended for patients whose thoracic ducts are ligated during radical resection of a cancer in the thoracic esophagus.
authors.affiliation: Department of Surgery II, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Aiko
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yoshizumi
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Matsuyama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Maehara
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002277:Carcinoma / Q000097:blood / Q000628:therapy*; D004231:Diuresis / Q000502:physiology; D004750:Enteral Nutrition; D004938:Esophageal Neoplasms / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000209:etiology; D013897:Thoracic Duct / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8; D002097:C-Reactive Protein; D001663:Bilirubin