Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer

Abstract

This study was to assess the resting energy expenditure of patients with esophageal cancer using indirect calorimetry. Eight male patients with esophageal cancer and eight male healthy controls were enrolled in this study. All patients underwent transthoracic esophagectomy with lymph nodes dissections. The resting energy expenditure was measured preoperatively, and on postoperative day 7 and 14 using indirect calorimetry. Preoperatively, the measured resting energy expenditure/body weight in these patients was significantly higher than that of the controls (23.3 ± 2.1 kcal/kg/day vs 20.4 ± 1.6 kcal/kg/day), whereas the measured/predicted energy expenditure from the Harris-Benedict equation ratio was 1.01 ± 0.09, which did not differ significantly from the control values. The measured resting energy expenditure/body weight was 27.3 ± 3.5 kcal/kg/day on postoperative day 7, and 23.7 ± 5.07 kcal/kg/day on postoperative day 14. Significant increases in the measured resting energy expenditure were observed on postoperative day 7, and the measured/predicted energy expenditure ratio was 1.17 ± 0.15. In conclusion, patients with operable esophageal cancers were almost normometabolic before surgery. On the other hand, the patients showed a hyper-metabolic status after esophagectomy. We recommended that nutritional management based on 33 kcal/body weight/day (calculated by the measured resting energy expenditure × active factor 1.2-1.3) may be optimal for patients undergoing esophagectomy.

Keywords: esophagectomy; indirect calorimetry; resting energy expenditure.

Fig. 1

Measured resting energy expenditure (mREE)/body weight (BW) in patients with esophageal cancer and healthy controls. (a) The mREE/BW of the patients was significantly higher than that of the healthy controls. Values represent means ± SD. *p<0.05 compared with healthy controls. (b) Measured resting energy expenditure (mREE)/predicted resting energy expenditure (pREE) in patients with esophageal cancer and healthy controls. There were no significant differences between the mREE/pREE of patients and healthy controls. Values represent means ± SD.

Fig. 2

Respiratory quotients (RQ) in patients with esophageal cancer during the preoperative period. There were no significant differences between the RQ of the patients and healthy controls. Values represent means ± SD.

Fig. 3

(a) Changes in the measured resting energy expenditure (mREE) of patients undergoing esophagectomy for esophageal carcinoma. The mREE of the patients was significantly increased on postoperative day 7. Values represent means ± SD. *p<0.05 compared with preoperative values. (b) Changes in the measured resting energy expenditure (mREE)/predicted resting energy expenditure (pREE) ratio of patients undergoing esophagectomy. The mREE/pREE ratio was significantly increased on postoperative day 7. Values represent means ± SD. *p<0.05 compared with preoperative values.

Fig. 4

Changes in the respiratory quotients (RQ) in patients undergoing esophagectomy. There were no significant changes in the RQ during perioperative period. Values represent means ± SD.

Fig. 5

Changes in nutritional intake, including enteral nutrition and parenteral nutrition, as a percentage of the energy requirements of patients undergoing oesophagectomy. The energy requirements of the patients were calculated by the mREE × stress factor 1.2–1.3. Values represent means ± SD.