Pre-operative nutritional status does not alter the metabolic response to major gastrointestinal surgery in patients with oesophageal cancer

Malnutrition is associated with an increased incidence of perioperative morbidity and mortality. To evaluate the effect of malnutrition on the metabolic and inflammatory response to surgery in patients with oesophageal cancer, we studied the effects of oesophagectomy in six patients with major (13 center dot 9 (SE 1 center dot 3) %) weight loss and five patients with minor (0 center dot 7 (SE 0 center dot 6) %) weight loss in the 6 months before to surgery. Rates of appearance (R(n)) of glucose, glycerol, leucine and urea were determined by stable isotopically labelled tracer infusion before and after surgery. C-reactive protein was measured as an inflammation marker. BMI was lower in the patients with major weight loss than those with minor weight loss (20.3 (SE 0 center dot 7) and 24 center dot 9 (SE 1 center dot 5) kg/m(2), P=0 center dot 02). With the exception of greater glucose R(a) in the major weight loss than minor weight loss subjects (11 center dot 1 (SE 0 center dot 3) v. 9 center dot 5 (SE 0 center dot 3) mu mol/kg per min, P= 0 center dot 01), there were no differences in substrate kinetics before surgery between groups. Surgery increased glucose R(a), leucine R(a) and urea R(a) by 41, 24 and 58 %, respectively, in the total group. Changes in substrate kinetics in response to surgery were not different between patients with major and minor weight loss. Surgery increased C-reactive protein concentrations to a comparable extent in both groups. In conclusion, major upper gastrointestinal tract surgery in patients with oesophageal cancer elicits a catabolic response, characterized by increased inflammation, glucose production and protein breakdown. However, this catabolic response does not seem to be influenced by pre-operative nutritional status.