[The metabolic changes and nutritional management following radical surgery of esophageal cancer and total gastrectomy].

The metabolic changes after major surgery such as esophagectomy and total gastrectomy are remarkable. Postoperative levels of plasma catecholamines and glucagon were significantly higher in major surgery than those in the other operations (distal gastrectomy, cholecystectomy, mastectomy, etc). As the consequence of these hormonal changes, resting metabolic expenditure (RME) increased up to 30-40% above the predicted basal metabolic expenditure and blood glucose elevated to a high level. The relationships between RME, N-balance and energy intake after major surgery indicated that the intake of non-protein energy expenditure equal to RME was necessary in order to maintain N-balance. For the administration of enough energy after major surgery, TPN solution composed of glucose 180-240g, fructose 90-100g, xylitol 30-40g and amino acids 68-91g (the approximate weight ratio of G, F and X is 4: 2: 1) was developed since 1975 and in some cases, lipid solution was added as non-protein energy source. This solution was infused immediately after operation and no metabolic complications (hyper glycemia, acidosis, etc) were observed. This nutritional therapy has maintained the nutritional state of postoperative patients and improved our operative results. There are, however, many problems in the nutritional managements of the patients with severe complications and after the discharge of hospital. In the future, special nutritional therapy for these cases should be progressed.