Nutritional consequences of surgical resection of the gastrointestinal tract for cancer.

the preoperative deficiency if nutritional intake has been hampered by these intake problems. Since the nutritional sequelae of the resection of anatom ical structures in the head and neck are on a mechanical rather than a metabolic basis, the clinical solutions are likewise mechanical ones. For short-term nutritional main tenance, both before and after operation, the patient can be fed by a nasopharyngeal or nasogastric tube. A frequent lack of emphasis on preoperative nutritional support is cer tainly a partial explanation for the postoperative wound problems that often plague the postoperative period. Ade quate alimentation can be accomplished for both the re placement of preexisting nutritional defects, and postoper ative maintenance, by using appropriately prepared high calorie liquid diets. For patients requiring long-term tube feeding due to permanent intake disability or protracted reconstructive procedures in the post-resection interval, a cervical tube esophagostomy is often preferable to the na sal tube. This procedure is easily accomplished either at the completion of the resection or at a later time. Resection of Cancer of the Thoracic Esophagus Careful appraisal of patients undergoing total or partial resection of the thoracic esophagus for cancer led to the observation that patients had varying degrees of clinical steatorrhea and diarrhea following these procedures. De tailed metabolic studies of a series of patients by Shils and Gilat (66) led to clear-cut evidence of laboratory steatorrhea in all patients when quantitative stool fat excretion meas urements were made (Table 2) but carbohydrate, nitrogen, vitamin B12,and electrolyte absorption measurements were virtually normal. These and other studies (52, 54, 64) dem onstrated data similar to those obtained in patients sub jected to truncal vagotomy and a gastric drainage proce dure, although the effect on fat absorption was generally greater in patients undergoing thoracic esophageal resec tion. These reports are convincing in regard to the major role played by vagotomy in the production of the observed malabsorption and the diarrhea, but the mechanisms are not completely clear. Attempts to correct both this mild diarrhea and malab sorption after esophagectomy by feeding pancreatic and biliary supplements or the use of a gluten-free diet were unsuccessful. The substitution of medium-chain triglycer ides for the longer-chain fatty acids did reduce fecal fat excretion in patients with malabsorption (64). Another po tential solution to this metabolic defect observed in some patients after partial or total resection of the thoracic esophagus might well be preservation of the …