Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Surg Today. 2009;39(10):855-60. doi: 10.1007/s00595-009-3967-z. Epub 2009 Sep 27.
A preoperative immunonutrition pharmaceutics diet (IMPACT) significantly reduced the incidence of postoperative infectious complications, but the optimal regimen still remains unclear. We evaluated the optimal dose of a preoperative IMPACT for patients with esophageal carcinoma and the incidence of postoperative complications based on the dose of IMPACT.
This study design was a prospective nonrandomized study. Twenty patients with thoracic esophageal carcinoma who underwent a right transthoracic subtotal esophagectomy were divided into two groups. These patients were administered immunonutrition of 500 ml/day (IMP500) or 1000 ml/day (IMP1000) for 7 days before the operation.
The incidence of postoperative mortality and morbidity was not different between the IMP500 group and the IMP1000 group. No difference was observed in the perioperative changes in inflammatory, immunological and nutritional variables between the two groups. There were no adverse effects in the IMP500 group, but four patients (40%) had diarrhea and four patients (40%) had appetite loss in the IMP1000 group. In the IMP1000 group, only four patients (40%) could take 1000 ml, but others reduced the quantity of IMPACT because of diarrhea and discomfort.
This study suggests that 500 ml of IMPACT is recommended as an optimal dose for patients with esophageal cancer.
术前免疫营养制剂饮食（IMPACT）可显著降低术后感染性并发症的发生率，但最佳方案仍不清楚。我们根据 IMPACT 的剂量评估了食管癌患者术前最佳 IMPACT 剂量和术后并发症的发生率。
本研究设计为前瞻性非随机研究。20 例接受右经胸食管次全切除术的胸段食管癌患者分为两组。这些患者在手术前 7 天接受 500 毫升/天（IMP500）或 1000 毫升/天（IMP1000）的免疫营养治疗。
IMP500 组和 IMP1000 组术后死亡率和发病率无差异。两组围手术期炎症、免疫和营养变量的变化无差异。IMP500 组无不良反应，但 IMP1000 组 4 例（40%）腹泻，4 例（40%）食欲下降。在 IMP1000 组中，只有 4 例（40%）患者能服用 1000 毫升，而其他患者因腹泻和不适而减少了 IMPACT 的用量。
本研究表明，500 毫升 IMPACT 是食管癌患者的最佳推荐剂量。
