Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma

Liang Shun Wang, Hsiao Yi Lin, Chun Ju Chang, Huei Jyh Fahn, Min Hsiung Huang, Chien Fu Jeff Lin

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and Objectives: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. Methods: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-α and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. Results: All the parameters in nutritional assessment declined profoundly by the third postoperative day (P <0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (>1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P <0.05), but immunoglobulins and complements decreased significantly yet variably (P <0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P <0.05). Conclusions: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.

Original languageEnglish
Pages (from-to)90-98
Number of pages9
JournalJournal of Surgical Oncology
Volume67
Issue number2
DOIs
Publication statusPublished - Feb 1998
Externally publishedYes

Fingerprint

Esophagectomy
Nutritional Status
Carcinoma
Iron
Nutrition Assessment
C-Reactive Protein
Immunoglobulins
Lymphocytes
Complement C4
CD4-CD8 Ratio
Complement C3
Lymphocyte Subsets
Lymphocyte Count
Transferrin
Serum Albumin
Magnesium
Esophagus
Interleukin-2
Zinc
Blood Proteins

Keywords

  • Esophageal carcinoma
  • Esophagectomy
  • Nutrition and immune status

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma. / Wang, Liang Shun; Lin, Hsiao Yi; Chang, Chun Ju; Fahn, Huei Jyh; Huang, Min Hsiung; Lin, Chien Fu Jeff.

In: Journal of Surgical Oncology, Vol. 67, No. 2, 02.1998, p. 90-98.

Research output: Contribution to journalArticle

Wang, Liang Shun ; Lin, Hsiao Yi ; Chang, Chun Ju ; Fahn, Huei Jyh ; Huang, Min Hsiung ; Lin, Chien Fu Jeff. / Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma. In: Journal of Surgical Oncology. 1998 ; Vol. 67, No. 2. pp. 90-98.
@article{5eeb3c1dd4314bc9a05b6f45ad2e8846,
title = "Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma",
abstract = "Background and Objectives: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. Methods: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-α and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. Results: All the parameters in nutritional assessment declined profoundly by the third postoperative day (P <0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (>1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P <0.05), but immunoglobulins and complements decreased significantly yet variably (P <0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P <0.05). Conclusions: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.",
keywords = "Esophageal carcinoma, Esophagectomy, Nutrition and immune status",
author = "Wang, {Liang Shun} and Lin, {Hsiao Yi} and Chang, {Chun Ju} and Fahn, {Huei Jyh} and Huang, {Min Hsiung} and Lin, {Chien Fu Jeff}",
year = "1998",
month = "2",
doi = "10.1002/(SICI)1096-9098(199802)67:2<90::AID-JSO4>3.0.CO;2-G",
language = "English",
volume = "67",
pages = "90--98",
journal = "Journal of Surgical Oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma

AU - Wang, Liang Shun

AU - Lin, Hsiao Yi

AU - Chang, Chun Ju

AU - Fahn, Huei Jyh

AU - Huang, Min Hsiung

AU - Lin, Chien Fu Jeff

PY - 1998/2

Y1 - 1998/2

N2 - Background and Objectives: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. Methods: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-α and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. Results: All the parameters in nutritional assessment declined profoundly by the third postoperative day (P <0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (>1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P <0.05), but immunoglobulins and complements decreased significantly yet variably (P <0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P <0.05). Conclusions: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.

AB - Background and Objectives: En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy. Methods: Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-α and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level. Results: All the parameters in nutritional assessment declined profoundly by the third postoperative day (P <0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (>1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P <0.05), but immunoglobulins and complements decreased significantly yet variably (P <0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P <0.05). Conclusions: Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.

KW - Esophageal carcinoma

KW - Esophagectomy

KW - Nutrition and immune status

UR - http://www.scopus.com/inward/record.url?scp=0031912613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031912613&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1096-9098(199802)67:2<90::AID-JSO4>3.0.CO;2-G

DO - 10.1002/(SICI)1096-9098(199802)67:2<90::AID-JSO4>3.0.CO;2-G

M3 - Article

VL - 67

SP - 90

EP - 98

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

SN - 0022-4790

IS - 2

ER -