Preoperative immunosuppression: Its relationship with high morbidity and mortality in patients receiving thoracic esophagectomy

The operative procedure for thoracic esophageal cancer, including thoracoto my, laparotomy, and three-field lymph node dissection, is a particularly st ressful surgery that is characterized by high morbidity and mortality. The aim of this study was to evaluate the immunologic and nutritional states of patients to determine possible predictive factors of morbidity and mortali ty in patients receiving thoracic esophagectomy. Patients receiving thoraci c esophagectomy were retrospectively divided into two groups. One group had postoperative infectious complications (group C+, n = 27), and the other h ad no complications (group C-, n = 76). They were treated with total parent eral nutrition or enteral nutrition providing 35-40 kcal . kg(-1).d(-1) of energy and 1.3-1.5 kcal . kg(-1).d(-1) of amino acids throughout the study period. The phytohemagglutinin (PHA)- and concanavalin A (Con A)-induced pr oliferation of peripheral blood mononuclear cells (PBMC) from the patients were measured before and at days 7 and 21 after the operation. Serum albumi n, prealbumin, transferrin, the retinol binding protein, and the C-reactive protein were also evaluated. Three patients out of 27 in group C+ died bec ause of severe infectious complications, whereas none of patients was fatal in group C-. PHA- and Con A-induced proliferation of PBMC was significantl y low before the operation and remained suppressed on the 21st postoperativ e day in group C+. No significant difference was observed in nutritional st atus during the perioperative days between the two groups. Our results indi cate that esophageal cancer patients with preoperative suppression of the c ell-mediated immunity can be identified as a higher risk population in the postoperative period, When adequate nutrition is received, however, the cor relation between nutritional status and mortality disappears. Nutrition 200 1;17:13-17. (C)Elsevier Science Inc. 2001.