The Annals of Thoracic Surgery, Vol 38, 617-621, Copyright © 1984 by The Society of Thoracic Surgeons
Clinical impact of intravenous hyperalimentation on esophageal carcinoma: is it worthwhile?
SJ Brister, RC Chiu, RA Brown and DS Mulder
The coexistence of malignancy and dysphagia makes nutritional deprivation
especially serious in patients with carcinoma of the esophagus. Intravenous
hyperalimentation (IVH) is often given and should be of particular value in
these patients. Sixty-four patients with carcinoma of the esophagus seen
between January, 1975, and February, 1982, were studied retrospectively
during their first hospitalization for the disease. Thirty-seven patients
received IVH, and 27 did not. There were no significant differences at the
time of admission to the hospital between the two groups with respect to
age, sex, pathological status, and location of the carcinoma. Also, there
was no difference in the incidence of hypoalbuminemia (less than 3 gm/dl)
or lymphocytopenia (less than 1,500/mm3). More patients in the IVH group
underwent surgical resection of the esophagus. Surgical intervention did
not significantly influence hospital mortality. The IVH therapy reduced
weight loss (p less than 0.05), but was associated with an increased
incidence of pulmonary sepsis (p less than 0.05) and longer hospital stay.
The incidence of hypoalbuminemia and lymphocytopenia increased between
admission and the end of hospitalization, but it did not significantly
differ between the groups. Thus, one cannot assume the effectiveness of IVH
in this clinical setting, as its value was not demonstrated in this
retrospective series. A prospective randomized study is warranted in view
of the high cost and the doubtful clinical impact of an IVH regimen in
patients with carcinoma of the esophagus.
