title: Preoperative oral supplementation support in patients with esophageal cancer.
abstract: OBJECTIVE
  Surgeries for cancer of the esophagus are still associated with a high rate of postoperative morbidity. There are few reports of perioperative nutritional support for patients undergoing esophageal cancer surgery, and there is insufficient evidence to recommend routine use of immunonutrition in these patients. The aim of this study was to determine whether preoperative immunonutrition positively influences key clinical outcomes such as postoperative infectious complications, mortality, length of hospital stay, and short-term survival in this population.
  
  
  METHODS
  We undertook a retrospective investigation of the effects of preoperative nutritional support on the postoperative course of esophageal cancer surgery at the Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
  
  
  METHODS
  Fifty-five patients who underwent esophagectomy for esophageal cancer were included in this study. Of the 55 patients, 26 patients consumed a liquid dietary supplement (IMPACT group) before surgery and 29 patients did not (STANDARD group).
  
  
  METHODS
  Before surgery, the IMPACT group consumed 750 ml (3 packs)/day of Impact for 5 consecutive days.
  
  
  METHODS
  The analysis was based on postoperative complications, hospital mortality, length of hospital stay, and short-term survival.
  
  
  RESULTS
  Significantly fewer patients developed postoperative infections in the IMPACT group compared with the STANDARD group (p=.007): 4 of 21 patients in the IMPACT group and 10 of 29 patients in the STANDARD group. Either an infectious complication or another complication developed in 8 patients in the IMPACT group and 13 patients in the STANDARD group, with the result that 6 patients in the STANDARD group died of postoperative complications (p=.001). The duration of hospitalization was 34 days in the IMPACT group and 48 days in the STANDARD group; hence, hospitalization was significantly shorter in patients treated with Impact (p=.008). The mean 6-month survival rates for the IMPACT group and the STANDARD group were 92% (24/26) and 72% (21/29), respectively (p=.028).
  
  
  CONCLUSIONS
  Simple preoperative supplementation significantly improved outcome. Administration of the supplemental diet before esophageal surgery appeared to be an effective strategy in reducing infectious complications, mortality, and hospitalization, and improving short-term survival.
authors.affiliation: K. Kubota, M.D., Ph.D., Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan, Tel: +81-3-3451-8121; Fax: +81-3-3454-0067; E-mail: kubota@iuhw.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: J
authors.initials: J
authors.lastname: Kuroda
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: A
authors.initials: A
authors.lastname: Okada
authors.forename: T
authors.initials: T
authors.lastname: Deguchi
authors.forename: M
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D019587:Dietary Supplements; D004938:Esophageal Neoplasms / Q000178:diet therapy* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome