Immunonutrition risk factors of respiratory complications after esophagectomy.
BACKGROUND
There are many reports suggesting predictive factors for respiratory complications after esophagectomy, but few studies have focused on this problem from the aspect of immunonutrition.


METHODS
A series of 45 esophageal cancer patients who underwent potentially curative resection between April 1996 and March 2001 was enrolled in this study. Preoperative and intraoperative variables were analyzed for a correlation between risk factors and respiratory complications. In this study, immunonutrition variables as assessed by ultrasonography and indirect calorimetry were used. Uni- and multivariate analyses were performed to determine the predictive factors.


RESULTS
Of 45 patients, nine patients (20%) developed respiratory complications. In univariate analysis, forced expiratory volume in 1 s per body surface area (m(2)) in preoperative respiratory parameters, respiratory quotient, and caloric contributions of fat (percentage) and carbohydrate according to indirect calorimetry, and serum CH50 level significantly influenced the occurrence of postoperative respiratory complications. In multivariate analysis, the caloric contribution of fat (percentage) by indirect calorimetry and serum alpha(1)-antitrypsin (serine protease inhibitor) independently affected the occurrence of respiratory complications.


CONCLUSIONS
Preoperative excessive fat oxidation (potential starvation) and alpha(1)-antitrypsin were independent predictive factors for postoperative complications. Nutrition support such as enteral feeding to improve this malnourished state would reduce the incidence of postoperative respiratory complications.
Kunisaki
Chikara
C
Second Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan. s0714@med.yokohama-cu.ac.jp
Shimada
Hiroshi
H
Nomura
Masato
M
Matsuda
Goro
G
Otsuka
Yuichi
Y
Ono
Hidetaka
H
Akiyama
Hirotoshi
H
D000704:Analysis of Variance; D015992:Body Mass Index; D002153:Calorimetry, Indirect; D004734:Energy Metabolism; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007109:Immunity; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D000515:alpha 1-Antitrypsin / Q000032:analysis
D000515:alpha 1-Antitrypsin